Provider Demographics
NPI:1568282242
Name:CAMPBELL, VALERIE MARIKO (OD)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:MARIKO
Last Name:CAMPBELL
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 1:8150 W HAUSMAN RD APT 3901
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-4193
Mailing Address - Country:US
Mailing Address - Phone:210-362-4292
Mailing Address - Fax:
Practice Address - Street 1:7342 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6224
Practice Address - Country:US
Practice Address - Phone:210-276-2256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11303T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist