Provider Demographics
NPI:1982786042
Name:KEPP, BRADLEY P (OD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:P
Last Name:KEPP
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 1:25 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-3323
Mailing Address - Country:US
Mailing Address - Phone:406-683-2020
Mailing Address - Fax:406-683-6409
Practice Address - Street 1:25 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-3323
Practice Address - Country:US
Practice Address - Phone:406-683-2020
Practice Address - Fax:406-683-6409
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT721OPT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000027601OtherBCBS MT
MT048-3038Medicaid
MT000027601OtherBCBS MT
MTU66686Medicare UPIN