Provider Demographics
NPI:1174768949
Name:KEMP FAMILY EYE CARE, LLC
Entity type:Organization
Organization Name:KEMP FAMILY EYE CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:DON
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:417-777-9000
Mailing Address - Street 1:325 S MAIN AVE
Mailing Address - Street 2:PO BOX 42
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-2052
Mailing Address - Country:US
Mailing Address - Phone:417-777-9000
Mailing Address - Fax:417-777-9003
Practice Address - Street 1:325 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-2052
Practice Address - Country:US
Practice Address - Phone:417-777-9000
Practice Address - Fax:417-777-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02963152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO313115305Medicaid
MO313115305Medicaid
MA1497Medicare PIN
6178130001Medicare NSC