Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1215251665 |
---|---|
Provider Name | Eric Joel Campbell |
First Address | Camas, WA 98607-9252 |
Second Address | Camas, WA 98607-9252 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2010 |
Last Update Date | 15/03/2010 |