NPIMap

Organization Active NPI

Clarkson Optometry Illinois, P.C.

Doing business as Clarkson Eyecare

  • Optometrist
  • Ballwin, MO
National Provider Identifier
1548635758
Registry record updated Jun 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
CLARKSON OPTOMETRY ILLINOIS, P.C.
Doing business as
Clarkson Eyecare
Practice address
15933 Clayton Rd Ste 201
Ballwin, MO 63011-2172
Phone
(636) 200-4393
Fax
(636) 527-0838
NPI assigned
Dec 14, 2015
Last updated
Jun 21, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2019

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

Authorized official

Name
Dr. James Wachter, ODNPI 1689670697
Title
Cpo
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
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

15933 Clayton Rd Ste 201
Ballwin, MO 63011-2172

Mailing address

PO Box 207163
Dallas, TX 75320-7154
Phone (636) 200-4393

Other names 1

  • Clarkson Eyecare Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170331001568 IL Part B Supplier - Clinic/Group Practice 7012292147 Receives reassigned benefits from 35 practitioners
Practice locations: Waterloo, IL; Swansea, IL; Staunton, IL; Shiloh, IL; Red Bud, IL; Mount Vernon, IL; Highland, IL; Granite City, IL…

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Clarkson Eyecare15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Locations

2525 Green Mount Commons Dr
Ste 290
Belleville, IL 62221
Phone (618) 233-7800

2121 S State Route 157
Edwardsville, IL 62025
Phone (618) 656-7774

10 Lincoln Hwy
Ste 101
Fairview Hts, IL 62208
Phone (618) 624-0222

Practitioners & affiliated clinicians

Practitioners 37

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 37

NPI Registry JSON

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

{
    "created_epoch": "1450051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561075200000",
    "number": "1548635758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 207163",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753207154",
            "telephone_number": "636-200-4393",
            "fax_number": "636-527-0838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15933 CLAYTON RD STE 201",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630112172",
            "telephone_number": "636-200-4393",
            "fax_number": "636-527-0838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKSON OPTOMETRY ILLINOIS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-14",
        "last_updated": "2019-06-21",
        "status": "A",
        "authorized_official_last_name": "WACHTER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CPO",
        "authorized_official_telephone_number": "636-200-4393",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clarkson Eyecare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clarkson Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ballwin, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 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.