Individual
DR. JEREMY SHANE CAMPBELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
14378 HIGHWAY 43, RUSSELLVILLE, AL 35653-2568
(256) 332-1355
(256) 332-1315
Mailing address
14378 HIGHWAY 43, RUSSELLVILLE, AL 35653-2568
(256) 332-1355
(256) 332-1315
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S-A80-TA-660
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009940024
—
AL
05
—
529930260
—
AL
Enumeration date
09/25/2006
Last updated
10/27/2010
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