Provider Demographics
NPI:1811081243
Name:CAMPAGNA, DAVID NEIL (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:NEIL
Last Name:CAMPAGNA
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 1:12100 SE STEVENS CT
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-8707
Mailing Address - Country:US
Mailing Address - Phone:503-353-7270
Mailing Address - Fax:503-353-7292
Practice Address - Street 1:12100 SE STEVENS CT
Practice Address - Street 2:SUITE 106
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-8707
Practice Address - Country:US
Practice Address - Phone:503-353-7270
Practice Address - Fax:503-353-7292
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1370ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist