Basic Information
| Provider Information | |||||||||
| NPI: | 1609936319 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | O.D.P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7638 STONEBROOK PKWY | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750341003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727121010 | ||||||||
| FaxNumber: | 9727121011 | ||||||||
| Practice Location | |||||||||
| Address1: | 7638 STONEBROOK PKWY | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750341003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727121010 | ||||||||
| FaxNumber: | 9727121011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 07/23/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WC0802X | 3923TG | TX | N | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | 152W00000X | 3923TG | TX | Y | Eye and Vision Services Providers | Optometrist | 152WX0102X | 3923TG | TX | N | Eye and Vision Services Providers | Optometrist | Occupational Vision | 152WP0200X | 3923TG | TX | N | Eye and Vision Services Providers | Optometrist | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1902852346 | 01 | TX | GROUP NPI | OTHER | 8DT969 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 1234530001 | 01 | TX | DMERC | OTHER | 00E41Y | 01 | TX | GROUP PIN | OTHER | K0122300 | 01 | TX | DPS | OTHER | MC0815172 | 01 | TX | DEA | OTHER | 3923TG | 01 | TX | STATE LICENSE | OTHER | 752711435 | 01 | TN | GROUP TAX ID | OTHER | 1609936319 | 01 | TX | NPI | OTHER |