Provider Demographics
NPI:1568878544
Name:KEMP, ANDREW P (OD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:P
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 1:655 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-4821
Mailing Address - Country:US
Mailing Address - Phone:817-289-6800
Mailing Address - Fax:817-289-6825
Practice Address - Street 1:655 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-4821
Practice Address - Country:US
Practice Address - Phone:817-289-6800
Practice Address - Fax:817-289-6825
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8428TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1124091-04Medicaid
TX00E63GMedicare PIN