1801978200 NPI number — DR. SCOTT WELLS CAMPBELL O.D.

Table of content: DR. SCOTT WELLS CAMPBELL O.D. (NPI 1801978200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801978200 NPI number — DR. SCOTT WELLS CAMPBELL O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
SCOTT
Provider Middle Name:
WELLS
Provider Name Prefix Text:
DR.
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:
1801978200
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
609 GLENDALE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24333-2209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-236-3242
Provider Business Mailing Address Fax Number:
276-236-3250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
609 GLENDALE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24333-2209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-236-3242
Provider Business Practice Location Address Fax Number:
276-236-3250
Provider Enumeration Date:
10/19/2006

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:  0618000022 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 42679 . This is a "DAVIS VISION" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9205551 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117070 . This is a "EYE MED" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1054850001 . This is a "ADMINASTAR" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 217722 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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