Provider Demographics
NPI:1609936319
Name:CAMPBELL, JAMES R JR (ODPC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:CAMPBELL
Suffix:JR
Gender:M
Credentials:ODPC
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7638 STONEBROOK PKWY
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1003
Mailing Address - Country:US
Mailing Address - Phone:972-712-1010
Mailing Address - Fax:972-712-1011
Practice Address - Street 1:7638 STONEBROOK PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1003
Practice Address - Country:US
Practice Address - Phone:972-712-1010
Practice Address - Fax:972-712-1011
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3923TG152WC0802X, 152W00000X, 152WX0102X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1902852346OtherGROUP NPI
TX8DT969OtherBLUE CROSS BLUE SHIELD
TX1234530001OtherDMERC
TX00E41YOtherGROUP PIN
TXK0122300OtherDPS
TX3923TGOtherSTATE LICENSE
TN752711435OtherGROUP TAX ID
TX1609936319OtherNPI
TX1609936319OtherNPI
TN752711435OtherGROUP TAX ID
TX00E41YOtherGROUP PIN
TXDO9312Medicare PIN