Provider Demographics
NPI:1942205711
Name:LAMPE, MARY KIRSCH (OD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:KIRSCH
Last Name:LAMPE
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 1:823 9TH ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-1521
Mailing Address - Country:US
Mailing Address - Phone:618-654-9848
Mailing Address - Fax:618-654-5200
Practice Address - Street 1:823 9TH ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-1521
Practice Address - Country:US
Practice Address - Phone:618-654-9848
Practice Address - Fax:618-654-5200
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008547152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046008547 1Medicaid
IL4669520007Medicare NSC
IL4669520005Medicare NSC
ILCK5584Medicare PIN
IL203194Medicare PIN
IL203193Medicare PIN
IL4669520002Medicare NSC
IL203195Medicare PIN
IL046008547 1Medicaid
IL4669520006Medicare NSC
IL410049381Medicare PIN