Provider Demographics
NPI:1467621870
Name:GARY G. CAMPBELL, OD, PC
Entity Type:Organization
Organization Name:GARY G. CAMPBELL, OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:G
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:781-878-1846
Mailing Address - Street 1:17 NORTH AVE
Mailing Address - Street 2:P.O. BOX 321
Mailing Address - City:ROCKLAND
Mailing Address - State:MA
Mailing Address - Zip Code:02370-2123
Mailing Address - Country:US
Mailing Address - Phone:781-878-1846
Mailing Address - Fax:781-878-0979
Practice Address - Street 1:17 NORTH AVE
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:MA
Practice Address - Zip Code:02370-2123
Practice Address - Country:US
Practice Address - Phone:781-878-1846
Practice Address - Fax:781-878-0979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2647152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0337781Medicaid
MAW15417OtherBLUE CROSS BLUE SHIELD
MA0479010001Medicare NSC
MA449958Medicare PIN
MA0337781Medicaid