MEDICARE: KEMP MILL OPTICAL LLC

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	TA1739	MD

General Provider Information

NPI Number	:	1952547747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEMP MILL OPTICAL LLC

Provider Business Mailing Address
First Line	:	1347 LAMBERTON DR
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-3415
Country	:	US
Telephone Number	:	301-754-1347
Fax Number	:	301-754-1350

Provider Business Practice Location Address
First Line	:	1347 LAMBERTON DR
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-3415
Country	:	US
Telephone Number	:	301-754-1347
Fax Number	:	301-754-1350

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. KATHERINE Y. LY
Credential	:	O.D.
Telephone Number	:	301-754-1347

Provider Enumeration Date	:	12/28/2008
Last Update Date	:	02/19/2009

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