Provider Demographics
NPI:1700889441
Name:CAMPBELL, JAMES M II (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:CAMPBELL
Suffix:II
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 1:103 DIECKS DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2444
Mailing Address - Country:US
Mailing Address - Phone:270-769-1397
Mailing Address - Fax:270-765-4899
Practice Address - Street 1:103 DIECKS DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2444
Practice Address - Country:US
Practice Address - Phone:270-769-1397
Practice Address - Fax:270-765-4899
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-26
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0584DT152WV0400X
KY0584 DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000046005OtherANTHEM BLUE CROSS
KY000000046005OtherFEDERAL EMPLOYEE PROGRAM
KY77008548Medicaid
KY900781OtherBLOCK VISION
KY000000046005OtherANTHEM BLUE CROSS
KY0145520001Medicare NSC
KY900781OtherBLOCK VISION