Clarkson Optometry Illinois PC
Organization Active NPI Optometrist · Waterloo, IL
NPI 1649464553 · NPPES record last updated Jun 21, 2019
Key facts
- NPI
- 1649464553
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 036104178 (IL)
- Legal business name
- CLARKSON OPTOMETRY ILLINOIS PC
- Practice address
- 204 Bradford Lane
Waterloo, IL 62298 - Phone
- (636) 200-4393
- Fax
- (618) 939-6037
- NPI assigned
- Sep 4, 2007
- Organization subpart
- No
Authorized official
- Name
- James J Wachter, OD
- Title
- Cmo
- Phone
- (636) 200-4393
Corporate family (same tax ID) 14
National Provider Directory
- Tax ID family
- Clarkson Eyecare
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 036104178 | IL | Yes |
Addresses
Primary practice location
204 Bradford Lane
Waterloo, IL 62298
Mailing address
PO Box 207163
Dallas, TX 75320-7154
Phone (636) 200-4393
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036104178 | Medicaid | IL |
Other names
- Clarkson Eyecare
Other providers in Waterloo, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 21, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.