Healthcare Provider Details

I. General information

NPI: 1386604411
Provider Name (Legal Business Name): JEFFREY ALAN KEMPF O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
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
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046009391
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: