NPIMap

Clarkson Optometry Midwest Inc

Organization Active NPI Optometrist · Coventry Township, OH

NPI 1730769696 · NPPES record last updated Apr 13, 2021

Key facts

NPI
1730769696
Entity type
Organization (NPI type 2)
Primary specialty
Optometrist 152W00000X
Legal business name
CLARKSON OPTOMETRY MIDWEST INC
Practice address
3510 Manchester Rd
Coventry Township, OH 44319-1415
Phone
(330) 753-2100
Fax
(330) 633-7165
NPI assigned
Apr 13, 2021
Organization subpart
No

Authorized official

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

Other NPIs on the same Medicare enrollment 9

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

Corporate family (same tax ID) 22

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

Practitioners 4

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in OH

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20150113001118 OH Part B Supplier - Clinic/Group Practice 0749504165 Receives reassigned benefits from 114 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gahanna, OH; Harrison, OH; Hilliard, OH; Kettering, OH; Lebanon, OH; Loveland, OH; Mansfield, OH; Marysville, OH…

National Provider Directory

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

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist
Group: 193400000X SINGLE SPECIALTY GROUP		 152W00000X Yes

Addresses

Primary practice location

3510 Manchester Rd
Coventry Township, OH 44319-1415

Mailing address

PO Box 207170
Dallas, TX 75320-7173
Phone (636) 200-4393

Other names

  • Clarkson Eyecare Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 13, 2021.

{
    "created_epoch": "1618272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618272000000",
    "number": "1730769696",
    "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": "753207173",
            "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": "3510 MANCHESTER RD",
            "city": "COVENTRY TOWNSHIP",
            "state": "OH",
            "postal_code": "443191415",
            "telephone_number": "330-753-2100",
            "fax_number": "330-633-7165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKSON OPTOMETRY MIDWEST INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-13",
        "last_updated": "2021-04-13",
        "certification_date": "2021-04-13",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clarkson Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coventry Township, OH

All providers in Coventry Township, OH · Optometrist in Ohio

Sources for this page

Verify at the official NPI Registry.