Provider Demographics
NPI:1386604411
Name:KEMPF, JEFFREY ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
Last Name:KEMPF
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6451 CHIPPEWA ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2104
Mailing Address - Country:US
Mailing Address - Phone:314-353-6171
Mailing Address - Fax:314-353-0031
Practice Address - Street 1:6451 CHIPPEWA ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2104
Practice Address - Country:US
Practice Address - Phone:314-353-6171
Practice Address - Fax:314-353-0031
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003002151152W00000X
IL046009391152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009391Medicaid
MOMA4910001Medicare PIN
IL202078Medicare ID - Type Unspecified
IL046009391Medicaid