Provider Demographics
NPI:1972684488
Name:KLEMP OPTOMETRY
Entity Type:Organization
Organization Name:KLEMP OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-743-4022
Mailing Address - Street 1:1910 IDAHO STREET
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2086
Mailing Address - Country:US
Mailing Address - Phone:208-743-4022
Mailing Address - Fax:208-746-0170
Practice Address - Street 1:1910 IDAHO STREET
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2086
Practice Address - Country:US
Practice Address - Phone:208-743-4022
Practice Address - Fax:208-746-0170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP897152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1369050OtherMEDICARE PTAN
WA2031375Medicaid
ID000010015178OtherREGENCE PROVIDER NO
DF0013OtherRAILROAD MEDICARE-PTAN
ID807324500Medicaid
IDV7166OtherBC OF ID GRP PROVIDER NO
ID000010015178OtherREGENCE PROVIDER NO
ID807324500Medicaid