Edward Sidney Campell, O.D.
Individual provider Active NPI Optometrist · Ewing, NJ
NPI 1710980784 · NPPES record last updated Aug 17, 2012
Key facts
- NPI
- 1710980784
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 270A00276400 (NJ)
- Practice address
- 94 Ridgewood Ave
Ewing, NJ 08618-1611 - Phone
- (609) 883-5083
- Fax
- (815) 572-5075
- NPI assigned
- May 24, 2005
- Reactivated
- Aug 17, 2012
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 270A00276400 | NJ | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Herbert J Bell P a | Optometrist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 270A00276400 | NJ | Yes |
Addresses
Primary practice location
94 Ridgewood Ave
Ewing, NJ 08618-1611
Mailing address
94 Ridgewood Ave
Ewing, NJ 08618-1611
Phone (609) 883-5083
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2584506 | Medicaid | NJ |
Other providers in Ewing, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.