NPIMap

Organization Active NPI

Clarkson Optometry Midwest Inc

Doing business as 20/20 EyeCare

  • Optometrist
  • Lebanon, KY
National Provider Identifier
1366520702
Registry record updated Oct 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1097DT Issued in KY
Legal business name
CLARKSON OPTOMETRY MIDWEST INC
Doing business as
20/20 EyeCare
Practice address
325 W Walnut St
Ste 400
Lebanon, KY 40033-1377
Phone
(636) 200-4393
NPI assigned
Nov 2, 2006
Last updated
Oct 3, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1097DT KY Primary

Addresses

Primary practice location

325 W Walnut St
Ste 400
Lebanon, KY 40033-1377

Mailing address

PO Box 207170
Dallas, TX 75320-7156
Phone (636) 200-4393

Other practice location 1

10232 Westport Rd
Louisville, KY 40241-2148
Phone (502) 339-2042

Other practice location 2

325 W Walnut St Ste 400
Lebanon, KY 40033-1380
Phone (270) 867-8200

Other practice location 3

544 Conestoga Pkwy Ste 17
Shepherdsville, KY 40165-5677
Phone (636) 200-4393 ext. 3064

Other practice location 4

10639 Dixie Hwy
Louisville, KY 40272-4349
Phone (636) 200-4393 ext. 3064

Other practice location 5

1709 N Dixie Ave
Elizabethtown, KY 42701-9496
Phone (636) 200-4393 ext. 3064

Other practice location 6

6828 Bardstown Rd
Louisville, KY 40291-3050
Phone (636) 200-4393 ext. 3064

Other practice location 7

1420 Blackiston Mill Rd Ste A
Clarksville, IN 47129-2290
Phone (812) 288-2029

Other names 1

  • 20/20 EyeCare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160526000461 KY Part B Supplier - Clinic/Group Practice 0749504165 Receives reassigned benefits from 59 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Shepherdsville, KY; Paducah, KY; Murray, KY; Mayfield, KY; Louisville, KY; Lebanon, KY; Fort Mitchell, KY; Elizabethtown, KY…
O20190327002362 IN Part B Supplier - Clinic/Group Practice 0749504165 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clarksville, IN

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member of 1

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

Locations

5855 Reliable Pkwy
Chicago, IL 60686
Phone (812) 288-2029

1420 Blackiston Mill Rd
Ste A
Clarksville, IN 47129
Phone (812) 288-2029

325 W Walnut St
Ste 400
Lebanon, KY 40033
Phone (270) 692-0047

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 30

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570060800000",
    "number": "1366520702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 207170",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753207156",
            "telephone_number": "636-200-4393",
            "fax_number": "636-527-0766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 W WALNUT ST",
            "address_2": "STE 400",
            "city": "LEBANON",
            "state": "KY",
            "postal_code": "400331377",
            "telephone_number": "636-200-4393"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10232 Westport Rd",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402412148",
            "country_code": "US",
            "telephone_number": "502-339-2042",
            "fax_number": "502-339-2044",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "325 W Walnut St Ste 400",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "KY",
            "postal_code": "400331380",
            "country_code": "US",
            "telephone_number": "270-867-8200",
            "fax_number": "270-867-8210",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "544 Conestoga Pkwy Ste 17",
            "address_purpose": "LOCATION",
            "city": "Shepherdsville",
            "state": "KY",
            "postal_code": "401655677",
            "country_code": "US",
            "telephone_number": "636-200-4393 x3064",
            "fax_number": "502-736-4488",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10639 Dixie Hwy",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402724349",
            "country_code": "US",
            "telephone_number": "636-200-4393 x3064",
            "fax_number": "502-736-4487",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1709 N Dixie Ave",
            "address_purpose": "LOCATION",
            "city": "Elizabethtown",
            "state": "KY",
            "postal_code": "427019496",
            "country_code": "US",
            "telephone_number": "636-200-4393 x3064",
            "fax_number": "502-765-4482",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6828 Bardstown Rd",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402913050",
            "country_code": "US",
            "telephone_number": "636-200-4393 x3064",
            "fax_number": "502-736-4485",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1420 Blackiston Mill Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "Clarksville",
            "state": "IN",
            "postal_code": "471292290",
            "country_code": "US",
            "telephone_number": "812-288-2029",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CLARKSON OPTOMETRY MIDWEST INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2019-10-03",
        "status": "A",
        "authorized_official_last_name": "WACHTER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "636-200-4393"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1097DT",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "20/20 EyeCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lebanon, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.