Provider Demographics
NPI:1912107905
Name:CAMPBELL, ANTONIO WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:WILLIAM
Last Name:CAMPBELL
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 1:955 W SOUTHERN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-4903
Mailing Address - Country:US
Mailing Address - Phone:480-961-1865
Mailing Address - Fax:
Practice Address - Street 1:6572 E GRANT RD STE 150
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3810
Practice Address - Country:US
Practice Address - Phone:520-886-6602
Practice Address - Fax:520-347-7738
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2750152W00000X
MN3669152W00000X
MO2020030535152W00000X
NYTUV007204152W00000X
NJ27OA00611900152W00000X
VA0618002846152W00000X
PAOEG001972152WC0802X, 152WL0500X, 152WX0102X, 152W00000X
AZOPT-002563152W00000X
FLTPOP24152W00000X
GAOPT003403152W00000X
IL046011388152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision