Provider Demographics
NPI:1194996579
Name:KEMPERAS VISION CENTER PC
Entity type:Organization
Organization Name:KEMPERAS VISION CENTER PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMPERAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-742-8742
Mailing Address - Street 1:1289 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-2990
Mailing Address - Country:US
Mailing Address - Phone:847-742-8742
Mailing Address - Fax:
Practice Address - Street 1:1289 W SPRING ST
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-2990
Practice Address - Country:US
Practice Address - Phone:847-742-8742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008537152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDT8785Medicare PIN