Provider Demographics
NPI:1417967324
Name:KEMP, NEIL WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:WILLIAM
Last Name:KEMP
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 1:1138 NEW BRITAIN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-2413
Mailing Address - Country:US
Mailing Address - Phone:860-236-0896
Mailing Address - Fax:860-236-0898
Practice Address - Street 1:1138 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-2413
Practice Address - Country:US
Practice Address - Phone:860-236-0896
Practice Address - Fax:860-236-0898
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2390152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
002390OtherCONNECTICARE
P2545366OtherOXFORD
0R4487OtherHEALTHNET
0R4487OtherHEALTHNET