Provider Demographics
NPI:1356453849
Name:CAMPBELL, ROBERT B (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:404 MEADOW PL
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-7362
Mailing Address - Country:US
Mailing Address - Phone:256-767-2595
Mailing Address - Fax:256-767-2967
Practice Address - Street 1:3100 HOUGH RD
Practice Address - Street 2:WAL-MART VISION CENTER STORE #0766
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-6902
Practice Address - Country:US
Practice Address - Phone:256-767-2595
Practice Address - Fax:256-767-2967
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS459TA282152W00000X
KY0951DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL07498OtherSPECTERA
AL51026767OtherBCBS
AL22586OtherAVESIS
AL924769OtherBLOCK VISION
AL63434OtherDAVIS
AL63434OtherDAVIS
AL205431572OtherNEW TAX ID NUMBER