Provider Demographics
NPI:1982741070
Name:CAMPBELL, JAMES R
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 CHATHAM ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1398
Mailing Address - Country:US
Mailing Address - Phone:718-668-2222
Mailing Address - Fax:718-668-9743
Practice Address - Street 1:2351 HYLAN BLVD
Practice Address - Street 2:VISION GALLERY LTD.
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3118
Practice Address - Country:US
Practice Address - Phone:718-668-2222
Practice Address - Fax:718-668-9743
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6571156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician