Provider Demographics
NPI:1942432976
Name:CAMPBELL, CAITLIN JEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:JEAN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 N MAIN
Mailing Address - Street 2:STE A103
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301
Mailing Address - Country:US
Mailing Address - Phone:970-382-8790
Mailing Address - Fax:970-382-8966
Practice Address - Street 1:2855 N MAIN
Practice Address - Street 2:STE A103
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301
Practice Address - Country:US
Practice Address - Phone:970-382-8790
Practice Address - Fax:970-382-8966
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-09
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2948152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation