Clarkson Optometry Midwest Inc
Organization Active NPI Optometrist · Lebanon, KY
NPI 1366520702 · NPPES record last updated Oct 3, 2019
Key facts
- NPI
- 1366520702
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 1097DT (KY)
- Legal business name
- CLARKSON OPTOMETRY MIDWEST INC
- Practice address
- 325 W Walnut St
Ste 400
Lebanon, KY 40033-1377 - Phone
- (636) 200-4393
- NPI assigned
- Nov 2, 2006
- Organization subpart
- No
Authorized official
- Name
- James Wachter
- Title
- Cmo
- Phone
- (636) 200-4393
Other NPIs on the same Medicare enrollment 3
Practitioners 29
-
Amanda M Ballard, OD
-
Hayley Childers, OD
-
Alicia Herrmann, O.D.
-
Lori Akridge McStoots, O.D.
-
Laurel Morris, O.D.
-
Dale Souleyrette, OD
-
Justin Ray Travis, O.D.
-
Joseph F Chatfield Jr., O.D.
-
David P. Dickson, O.D.
-
Lauren Kaspar, OD
-
John D Roberts, O.D.
-
Barbara Van, OD
-
Aida I Badillo, OD
-
Arthur Andrew Haley, O.D.
-
John Harold Matthews, O.D.
-
David Moore, OD
-
Charles Barrett Simpson, O.D.
-
Jeffrey Cole, OD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KY, IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
10232 Westport Rd
Louisville, KY 40241
Phone (502) 339-2042
6828 Bardstown Rd
Louisville, KY 40291
Phone (502) 231-2020
8118 Montgomery Rd
Cincinnati, OH 45236
Phone (513) 891-9030
4021 Far Hills Ave
Kettering, OH 45429
Phone (513) 863-2938
10566 Loveland Madeira Rd
Loveland, OH 45140
Phone (513) 683-3791
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 1097DT | KY | Yes |
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
- 20/20 EyeCare
Other providers in Lebanon, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.