Provider Demographics
NPI:1053099879
Name:CAMPBELL, ALECIA CAREY (LDO, ABOC)
Entity type:Individual
Prefix:MISS
First Name:ALECIA
Middle Name:CAREY
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LDO, ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12000 IRON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1459
Mailing Address - Country:US
Mailing Address - Phone:804-768-1273
Mailing Address - Fax:804-768-1594
Practice Address - Street 1:12000 IRON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1459
Practice Address - Country:US
Practice Address - Phone:804-768-1273
Practice Address - Fax:804-768-1594
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101004297156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician