Healthcare Provider Details

I. General information

NPI: 1174944011
Provider Name (Legal Business Name): PREMIUM VISION SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2013
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6451 CHIPPEWA ST
SAINT LOUIS MO
63109-2104
US

IV. Provider business mailing address

6451 CHIPPEWA ST
SAINT LOUIS MO
63109-2104
US

V. Phone/Fax

Practice location:
  • Phone: 314-353-6171
  • Fax: 314-353-0031
Mailing address:
  • Phone: 314-353-6171
  • Fax: 314-353-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2003002151
License Number StateMO

VIII. Authorized Official

Name: DR. JEFFREY ALAN KEMPF
Title or Position: OWNER
Credential: O.D.
Phone: 314-353-6171