Provider Demographics
NPI:1396580460
Name:KERR, EMMA (OD)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:KERR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6339 WINN RD
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MI
Mailing Address - Zip Code:48097-2109
Mailing Address - Country:US
Mailing Address - Phone:810-858-7605
Mailing Address - Fax:
Practice Address - Street 1:333 W NEPESSING ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2105
Practice Address - Country:US
Practice Address - Phone:810-664-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
MI4901005830152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program