Provider Demographics
NPI:1750398228
Name:KEMPFER, TARA AMBER (OD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:AMBER
Last Name:KEMPFER
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 1:810 N BAIRD AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-1617
Mailing Address - Country:US
Mailing Address - Phone:218-736-5609
Mailing Address - Fax:218-736-5600
Practice Address - Street 1:810 N BAIRD AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1617
Practice Address - Country:US
Practice Address - Phone:218-736-5609
Practice Address - Fax:218-736-5600
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD629152W00000X
MN3063152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNV11057Medicare UPIN