Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2231 | SC |
NPI | 1013515014 |
---|---|
Provider Name | Dr. Michael Richard Campbell |
First Address | Hilton Head Island, SC 29926-2838 |
Second Address | Hilton Head Island, SC 29926-2838 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2020 |
Last Update Date | 12/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2231 | (05) | SC |