Provider Demographics
NPI:1073682431
Name:KEMERLEY, STEPHEN D (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:D
Last Name:KEMERLEY
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 1:141 N WEBER RD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-1504
Mailing Address - Country:US
Mailing Address - Phone:630-378-4342
Mailing Address - Fax:630-378-4147
Practice Address - Street 1:141 N WEBER RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-1504
Practice Address - Country:US
Practice Address - Phone:630-378-4342
Practice Address - Fax:630-378-4147
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2016-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008120152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232658OtherBLUE CROSS BLUE SHIELD