Provider Demographics
NPI:1285663336
Name:MCCAMPBELL, KATHRYN R (OD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:R
Last Name:MCCAMPBELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12215 N ATKINS AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64163-7301
Mailing Address - Country:US
Mailing Address - Phone:641-414-7799
Mailing Address - Fax:
Practice Address - Street 1:7207 N M1 HWY
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64119-5351
Practice Address - Country:US
Practice Address - Phone:816-436-5823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2111152W00000X
IA02337152W00000X
MO2005020649152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA19129OtherWELLMARK
IA0492850Medicaid
IA250894OtherMIDLANDS CHOICE
IA292703OtherCOVENTRY
IA0492850Medicaid
IAI17769Medicare PIN