Provider Demographics
NPI:1760670582
Name:CAMPBELL EYE CARE PC
Entity Type:Organization
Organization Name:CAMPBELL EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VERN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-487-5315
Mailing Address - Street 1:932 SPRING ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2286
Mailing Address - Country:US
Mailing Address - Phone:231-487-5315
Mailing Address - Fax:231-487-5316
Practice Address - Street 1:932 SPRING ST STE 101
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2286
Practice Address - Country:US
Practice Address - Phone:231-487-5315
Practice Address - Fax:231-487-5316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIVC059657207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4549885Medicaid
MI0N78890Medicare PIN
MI5150030001Medicare NSC
MI4549885Medicaid