Provider Demographics
NPI:1306839881
Name:CAMPBELL, MICHAEL ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALLEN
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HOSPITAL CENTER CMNS
Mailing Address - Street 2:STE 100
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2839
Mailing Address - Country:US
Mailing Address - Phone:843-681-6682
Mailing Address - Fax:681-681-9582
Practice Address - Street 1:10 HOSPITAL CENTER CMNS
Practice Address - Street 2:STE 100
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2839
Practice Address - Country:US
Practice Address - Phone:843-681-6682
Practice Address - Fax:681-681-9582
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC841152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0282OtherGROUP NUMBER
SC3063Medicare ID - Type UnspecifiedGROUP NUMBER
SC410008055Medicare ID - Type UnspecifiedRR MEDICARE
SCT838863063Medicare PIN
SCT838660381Medicare PIN
0282OtherGROUP NUMBER
SC0279780001Medicare NSC