Provider Demographics
NPI:1659606739
Name:CAMPAIGN, PATRICK WAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:WAYNE
Last Name:CAMPAIGN
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 1:1231 W NORTHERN LIGHTS BLVD
Mailing Address - Street 2:SUITE 423
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2337
Mailing Address - Country:US
Mailing Address - Phone:907-306-3182
Mailing Address - Fax:
Practice Address - Street 1:1231 W NORTHERN LIGHTS BLVD
Practice Address - Street 2:SUITE 423
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2337
Practice Address - Country:US
Practice Address - Phone:907-306-3182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKOPT 338152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1597821Medicaid