Provider Demographics
NPI:1306286273
Name:CAMPOURIS, BESSIE (OD)
Entity type:Individual
Prefix:
First Name:BESSIE
Middle Name:
Last Name:CAMPOURIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11230 N TATUM BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-1641
Mailing Address - Country:US
Mailing Address - Phone:602-263-0850
Mailing Address - Fax:
Practice Address - Street 1:11230 N TATUM BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-1641
Practice Address - Country:US
Practice Address - Phone:602-263-0850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1910152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
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AZZ162078Medicare PIN
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AZZ162075Medicare PIN
AZZ162074Medicare PIN
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AZZ164151Medicare PIN
AZZ164154Medicare PIN