Provider Demographics
NPI:1477738698
Name:CAMPBELL, RENEE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4012 PRESTON RD
Mailing Address - Street 2:#500
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7368
Mailing Address - Country:US
Mailing Address - Phone:972-985-3638
Mailing Address - Fax:
Practice Address - Street 1:4012 PRESTON RD
Practice Address - Street 2:#500
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7368
Practice Address - Country:US
Practice Address - Phone:972-985-3638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3932T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist