Bradley S Camp, O.D.
Individual provider Active NPI Optometrist · North Manchester, IN
NPI 1790786093 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1790786093
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 18001838 (IN)
- Practice address
- 103 N Front St
North Manchester, IN 46962-1529 - Phone
- (260) 982-8798
- Fax
- (260) 982-1822
- NPI assigned
- Aug 9, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101118000331 | IN | Practitioner - Optometry | 5193843530 |
Reassigns benefits to 1 organization Practice locations: North Manchester, IN |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18001838 | IN | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Manchester Eyecare LLC | Optometrist | Current |
Accepting new patients |
| Hill Chiropractic LLC | Past |
Accepting new patients |
Locations
103 Front St
North Manchester, IN 46962
Phone (260) 306-0079
901 State Road 114 W
North Manchester, IN 46962
Phone (260) 306-3937
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 18001838 | IN | Yes |
Addresses
Primary practice location
103 N Front St
North Manchester, IN 46962-1529
Mailing address
103 Front St
PO Box 333
North Manchester, IN 46962-1529
Phone (260) 982-8798
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| IN1838 | Other | IN | EYEMED VISION CARE |
| 100105320A | Medicaid | IN | |
| 000000288123 | Other | ANTHEM |
Other providers in North Manchester, IN
- John Bazzoni
- Choice Physical Therapy Southwest LLC
- Russell Glendon Coulter-Kern
- Joel Eikenberry
- Family Hearing Center, Inc
- Erin R Foreman
All providers in North Manchester, IN · Optometrist in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.