Active NPI
James M Campbell II, O.D.
- Optometrist
- Elizabethtown, KY
National Provider Identifier
1700889441
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 0584 DT
- Practice address
- 103 Diecks Dr
Elizabethtown, KY 42701-2444 - Phone
- (270) 769-1397
- Fax
- (270) 765-4899
- NPI assigned
- May 26, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vision Therapy Optometrist | 152WV0400X | 0584DT | KY | |
| Optometrist | 152W00000X | 0584 DT | KY | Primary |
Addresses
Primary practice location
103 Diecks Dr
Elizabethtown, KY 42701-2444
Mailing address
103 Diecks Dr
Elizabethtown, KY 42701-2444
Phone (270) 769-1397
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000046005 | Other | KY | ANTHEM BLUE CROSS |
| 000000046005 | Other | KY | FEDERAL EMPLOYEE PROGRAM |
| 77008548 | Medicaid | KY | |
| 900781 | Other | KY | BLOCK VISION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0584 DT | KY | MD | Optometrist |
| 0584DT | KY | MD | Vision Therapy Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117065600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210204800000",
"number": "1700889441",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "103 DIECKS DR",
"city": "ELIZABETHTOWN",
"state": "KY",
"postal_code": "427012444",
"telephone_number": "270-769-1397",
"fax_number": "270-765-4899"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 DIECKS DR",
"city": "ELIZABETHTOWN",
"state": "KY",
"postal_code": "427012444",
"telephone_number": "270-769-1397",
"fax_number": "270-765-4899"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMPBELL",
"first_name": "JAMES",
"middle_name": "M",
"name_prefix": "Dr.",
"name_suffix": "II",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-05-26",
"last_updated": "2008-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "152WV0400X",
"taxonomy_group": "",
"desc": "Optometrist, Vision Therapy",
"state": "KY",
"license": "0584DT",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "KY",
"license": "0584 DT",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BLUE CROSS",
"identifier": "000000046005",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL EMPLOYEE PROGRAM",
"identifier": "000000046005",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "77008548",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLOCK VISION",
"identifier": "900781",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elizabethtown, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.