NPIMap

Individual provider Active NPI

Solomon Campbell, O.D.

  • Optometrist
  • Orem, UT
National Provider Identifier
1033457494
Registry record updated Jan 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
8706878-9934 Issued in UT
Practice address
209 N State St
Orem, UT 84057-4745
Phone
(801) 224-4799
Fax
(801) 434-4051
NPI assigned
Jan 19, 2013
Last updated
Jan 5, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 5, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 8706878-9934 UT Primary
Optometrist 152W00000X NV 759 NV

Addresses

Primary practice location

209 N State St
Orem, UT 84057-4745

Mailing address

742 N 530 E
Orem, UT 84097-4104
Phone (801) 224-4799

Other identifiers 1

IdentifierTypeStateIssuer
1033457494MedicaidUT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150204000978 UT Practitioner - Optometry 1052551629 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Complete Eye CareGroup PAC ID 1456657006, 2 clinicians

Practice addresses (Care Compare)

742 N 530
Orem, UT 84097-4104
Phone (801) 224-4799

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
NV 759NVMDOptometrist
8706878-9934UTMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Complete Eye Care Optometrist CurrentSince Jan 16, 2016 Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients
Standard Optical Co Optometrist Past Accepting new patients

Locations

209 N State St
Orem, UT 84057
Phone (801) 224-4799

742 N 530 E
Orem, UT 84097
Phone (801) 224-4799

Networks

  • UT PPO D-SNP
  • UT PPO

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609804800000",
    "number": "1033457494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "742 N 530 E",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840974104",
            "telephone_number": "801-224-4799",
            "fax_number": "801-434-4051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 N STATE ST",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840574745",
            "telephone_number": "801-224-4799",
            "fax_number": "801-434-4051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "SOLOMON",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-01-19",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "8706878-9934",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NV",
            "license": "NV 759",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1033457494",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orem, UT

Sources for this page

Verify at the official NPI Registry.