Provider Demographics
NPI:1154441350
Name:VANCAMP, JAMES THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:THOMAS
Last Name:VANCAMP
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1009
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-1009
Mailing Address - Country:US
Mailing Address - Phone:719-598-6000
Mailing Address - Fax:719-559-0136
Practice Address - Street 1:1465 KELLY JOHNSON BLVD
Practice Address - Street 2:STE 110
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3955
Practice Address - Country:US
Practice Address - Phone:719-598-6000
Practice Address - Fax:719-559-0136
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT1190152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08011900Medicaid
CO08011900Medicaid
CO35953Medicare UPIN
CO08011900Medicaid