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Clarkson Optometry Inc

Organization Active NPI Optometrist · Fenton, MO

NPI 1114970779 · NPPES record last updated Jun 6, 2019

Key facts

NPI
1114970779
Entity type
Organization (NPI type 2)
Primary specialty
Optometrist 152W00000X
Legal business name
CLARKSON OPTOMETRY INC
Practice address
699 Gravois Bluffs Blvd
Fenton, MO 63026-7715
Phone
(636) 200-4393
Fax
(636) 305-1021
NPI assigned
May 17, 2006
Organization subpart
No

Authorized official

Name
James Wachter NPI 1689670697
Title
Cmo
Phone
(636) 200-4393

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Other NPIs with the same Medicare PAC ID 16

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners 83

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 83

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MO

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20141201001730 MO DME Supplier - Physician - Optometrist 0840411799 Practice locations: Fenton, MO

National Provider Directory

Tax ID family
Clarkson Optometry Inc (44 organizations share this tax ID)

Locations

699 Gravois Bluffs Blvd
Fenton, MO 63026
Phone (636) 349-3005

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist
Group: 193400000X SINGLE SPECIALTY GROUP		 152W00000X Yes

Addresses

Primary practice location

699 Gravois Bluffs Blvd
Fenton, MO 63026-7715

Mailing address

15933 Clayton Rd
Suite 201
Ballwin, MO 63011-2172
Phone (636) 200-4393

Other identifiers

IdentifierTypeStateIssuer
723835007OtherMODMERC

Other names

  • Clarkson Eyecare Doing business as

Other providers in Fenton, MO

All providers in Fenton, MO · Optometrist in Missouri

Sources for this page

Verify at the official NPI Registry.