Provider Demographics
NPI:1891544144
Name:CAMPBELL, REBECCA (OD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
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 1:525 SILLIMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16511-2054
Mailing Address - Country:US
Mailing Address - Phone:814-860-0238
Mailing Address - Fax:
Practice Address - Street 1:2640 W 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-4524
Practice Address - Country:US
Practice Address - Phone:814-835-8258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG004142152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist