Provider Demographics
NPI:1649706847
Name:KRYSTAL KEMPF EYE CARE PLLC
Entity type:Organization
Organization Name:KRYSTAL KEMPF EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:517-927-2712
Mailing Address - Street 1:2914 AMHERST DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-2401
Mailing Address - Country:US
Mailing Address - Phone:517-927-2712
Mailing Address - Fax:517-647-5445
Practice Address - Street 1:1311 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:MI
Practice Address - Zip Code:48875-1601
Practice Address - Country:US
Practice Address - Phone:517-647-7515
Practice Address - Fax:517-647-5445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004448152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC46508001Medicare UPIN