Provider Demographics
NPI:1487660403
Name:KEMPFER, RANDALL JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:JAMES
Last Name:KEMPFER
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 1:810 N BAIRD AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-1617
Mailing Address - Country:US
Mailing Address - Phone:218-763-5609
Mailing Address - Fax:218-736-5600
Practice Address - Street 1:810 N BAIRD AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1617
Practice Address - Country:US
Practice Address - Phone:218-763-5609
Practice Address - Fax:218-736-5600
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD628152W00000X
MN3062152W00000X
ND646152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN410035867Medicare PIN