Provider Demographics
NPI:1326003518
Name:CAMPBELL, SCOTT M (OD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
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 1:605 STEWART ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1211
Mailing Address - Country:US
Mailing Address - Phone:206-682-9515
Mailing Address - Fax:206-957-8440
Practice Address - Street 1:605 STEWART ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1211
Practice Address - Country:US
Practice Address - Phone:206-682-9515
Practice Address - Fax:206-957-8440
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001869152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2031441Medicaid
WA8856565Medicare ID - Type Unspecified
WAU23799Medicare UPIN