Provider Demographics
NPI:1558385583
Name:CAMPBELL, STEVEN ERIC (OD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ERIC
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:PO BOX 12564
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-0564
Mailing Address - Country:US
Mailing Address - Phone:210-496-9803
Mailing Address - Fax:210-496-0313
Practice Address - Street 1:1900 N MAIN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3942
Practice Address - Country:US
Practice Address - Phone:210-496-9803
Practice Address - Fax:210-496-0313
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04011TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128933201Medicaid
TX3047098001OtherCIGNA FLEX POS
TX3047098002OtherCIGNA COM HMO
TX5486005OtherAETNA
TX7891175OtherAETNA - GROUP ID
TX84P071OtherBLUE CROSS BLUE SHIELD
TX3364062OtherBLUE LINK - GROUP
TX410043241OtherMEDICARE RAILROAD
TX168300061OtherPACIFICARE OF TEXAS
TX8182084OtherBLUE CHOICE-BLUE LINK-INDIVIDUAL
TX2500839OtherUNITED HEALTH
TX3047098002OtherCIGNA COM HMO
TX3364062OtherBLUE LINK - GROUP