Provider Demographics
NPI:1942242912
Name:KEMMERER, LEWIS E (OD)
Entity Type:Individual
Prefix:MR
First Name:LEWIS
Middle Name:E
Last Name:KEMMERER
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:PO BOX 2200
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-0722
Mailing Address - Country:US
Mailing Address - Phone:909-793-3311
Mailing Address - Fax:909-796-4158
Practice Address - Street 1:1690 BARTON RD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4229
Practice Address - Country:US
Practice Address - Phone:909-793-3311
Practice Address - Fax:909-793-2916
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 8757152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0087570Medicaid
CASD0087570Medicaid