1558385583 NPI number — STEVEN ERIC CAMPBELL O.D.

Table of content: (NPI 1881960854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558385583 NPI number — STEVEN ERIC CAMPBELL O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
STEVEN
Provider Middle Name:
ERIC
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558385583
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12564
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78212-0564
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-496-9803
Provider Business Mailing Address Fax Number:
210-496-0313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 N MAIN AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78212-3942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-225-7183
Provider Business Practice Location Address Fax Number:
210-212-6659
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  04011TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 410043241 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 84P071 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 3047098001 . This is a "CIGNA FLEX POS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 3047098002 . This is a "CIGNA COM HMO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 019134802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2500839 . This is a "UNITED HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8182084 . This is a "BLUE CHOICE-BLUE LINK-INDIVIDUAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5486005 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7891175 . This is a "AETNA - GROUP ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 84P071 . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 168300061 . This is a "PACIFICARE OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 3364062 . This is a "BLUE LINK - GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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