Provider Demographics
NPI:1356515068
Name:S W CAMPBELL OD PC
Entity type:Organization
Organization Name:S W CAMPBELL OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:W
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:276-236-3242
Mailing Address - Street 1:609 GLENDALE RD
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2209
Mailing Address - Country:US
Mailing Address - Phone:276-236-3242
Mailing Address - Fax:276-236-3250
Practice Address - Street 1:609 GLENDALE RD
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2209
Practice Address - Country:US
Practice Address - Phone:276-236-3242
Practice Address - Fax:276-236-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000022152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
117070OtherEYE MED
217722OtherANTHEM
283501OtherSOUTHERN HEALTH
VA9205551Medicaid
42679OtherDAVIS VISION
T21630Medicare UPIN
1054850001Medicare NSC