Campbell, Jeremy Shane
Campbell, Jeremy Shane is an individual health care provider with primary practice located at 14378 Highway 43 , Russellville AL 35653-2568. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Campbell, Jeremy Shane can be contacted via phone (256) 332-1355.Contact Information
Primary practice address
14378 Highway 43
Russellville AL 35653-2568
Phone: (256) 332-1355
Fax: (256) 332-1315
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | S-A80-TA-660 | Alabama |
Profile Details
| NPI number | 1710088711 |
|---|---|
| LBN Legal business name | Campbell, Jeremy Shane |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 25th, 2006 |
| Last updated | Oct 27th, 2010 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1710088711 | NPPES |
| Alabama | MEDICAID | 529930260 | |
| Alabama | MEDICAID | 009940024 |
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