Provider Demographics
NPI:1942332101
Name:KEMPKES, PAUL T (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:T
Last Name:KEMPKES
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 1:138 BRICKYARD RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:NY
Mailing Address - Zip Code:14882-9018
Mailing Address - Country:US
Mailing Address - Phone:607-533-4680
Mailing Address - Fax:607-257-1763
Practice Address - Street 1:40 CATHERWOOD RD
Practice Address - Street 2:STERLING OPTICAL, PYRAMID MALL
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1056
Practice Address - Country:US
Practice Address - Phone:607-257-2333
Practice Address - Fax:607-257-1763
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTU-004675152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00991093Medicaid