Provider Demographics
NPI:1174513238
Name:KLEMP, DANIEL ROBERT (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ROBERT
Last Name:KLEMP
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 IDAHO STREET
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2053
Mailing Address - Country:US
Mailing Address - Phone:208-743-4022
Mailing Address - Fax:208-746-0170
Practice Address - Street 1:1910 IDAHO STREET
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2053
Practice Address - Country:US
Practice Address - Phone:208-743-4022
Practice Address - Fax:208-746-0170
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP897152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAKLEDA5047950479OtherPREMERA
ID000010015581OtherREGENCE
ID000309000Medicaid
IDV7167OtherBLUE CROSS OF IDAHO
WA2022739Medicaid
ID0133176OtherDEPT OF LABOR & INDUSTRY
ID000309000Medicaid
WA2022739Medicaid
ID1292380001Medicare NSC
WAKLEDA5047950479OtherPREMERA