MEDICARE: DR. NEIL WILLIAM KEMP O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2390	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	002390	OTHER	CONNECTICARE
2	P2545366	OTHER	OXFORD
3	0R4487	OTHER	HEALTHNET

General Provider Information

NPI Number	:	1417967324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEIL WILLIAM KEMP O.D.

Provider Business Mailing Address
First Line	:	1138 NEW BRITAIN AVE
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06110-2413
Country	:	US
Telephone Number	:	860-236-0896
Fax Number	:	860-236-0898

Provider Business Practice Location Address
First Line	:	1138 NEW BRITAIN AVE
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06110-2413
Country	:	US
Telephone Number	:	860-236-0896
Fax Number	:	860-236-0898

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	09/08/2007

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