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Clarkson Optometry Midwest Inc.

Organization Active NPI Optometrist · Benton, KY

NPI 1497948541 · NPPES record last updated Jul 8, 2019

Key facts

NPI
1497948541
Entity type
Organization (NPI type 2)
Primary specialty
Optometrist 152W00000X
License
1073DT (KY)
Legal business name
CLARKSON OPTOMETRY MIDWEST INC.
Practice address
109 W 5TH St
Benton, KY 42025-1123
Phone
(636) 200-4393
NPI assigned
Aug 22, 2007
Organization subpart
No

Authorized official

Name
James Wachter
Title
Owner
Phone
(636) 200-4393

Other NPIs with the same Medicare PAC ID 8

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

Corporate family (same tax ID) 22

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

Practitioners 78

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

View all 78

Medicare participation

Medicare fee-for-service enrollment
Enrolled in KY

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20190716002507 KY DME Supplier - Physician - Optometrist 0749504165 Practice locations: Benton, KY

National Provider Directory

Tax ID family
Clarkson Optometry Midwest (23 organizations share this tax ID)

Locations

15933 Clayton Rd
Dallas, TX 75320

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist
Group: 193200000X MULTI-SPECIALTY GROUP		 152W00000X 1073DT KY Yes
Optometrist
Group: 193200000X MULTI-SPECIALTY GROUP		 152W00000X 1469DT KY
Optometrist
Group: 193200000X MULTI-SPECIALTY GROUP		 152W00000X 1767DT KY

Addresses

Primary practice location

109 W 5TH St
Benton, KY 42025-1123

Mailing address

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

Other providers in Benton, KY

All providers in Benton, KY · Optometrist in Kentucky

Sources for this page

Verify at the official NPI Registry.