Provider Demographics
NPI:1255684262
Name:JULIE YOUNG CAMPBELL OD LLC
Entity Type:Organization
Organization Name:JULIE YOUNG CAMPBELL OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:YOUNG
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-249-7300
Mailing Address - Street 1:725 N TYNDALL PKWY
Mailing Address - Street 2:
Mailing Address - City:CALLAWAY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-3219
Mailing Address - Country:US
Mailing Address - Phone:850-785-3426
Mailing Address - Fax:850-785-6556
Practice Address - Street 1:725 N TYNDALL PKWY
Practice Address - Street 2:
Practice Address - City:CALLAWAY
Practice Address - State:FL
Practice Address - Zip Code:32404-3219
Practice Address - Country:US
Practice Address - Phone:850-785-3426
Practice Address - Fax:850-785-6556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP2920152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU51128Medicare UPIN