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Clarkson Optometry Inc

Organization Active NPI Optometrist · Saint Louis, MO

NPI 1790971968 · NPPES record last updated Jul 5, 2019

Key facts

NPI
1790971968
Entity type
Organization (NPI type 2)
Primary specialty
Optometrist 152W00000X
License
T03019 (MO)
Legal business name
CLARKSON OPTOMETRY INC
Practice address
2572 Lemay Ferry Rd
Saint Louis, MO 63125-3131
Phone
(636) 200-4393
Fax
(314) 845-9603
NPI assigned
Sep 20, 2007
Organization subpart
No

Authorized official

Name
James Wachter NPI 1689670697
Title
Cpo/Vice Chairman
Phone
(636) 200-4393

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Other NPIs with the same Medicare PAC ID 16

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

Corporate family (same tax ID) 43

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

View all 43

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners 83

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

View all 83

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MO

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20190214000916 MO DME Supplier - Physician - Optometrist 0840411799 Practice locations: Saint Louis, MO

National Provider Directory

Tax ID family
Clarkson Optometry Inc (44 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist
Group: 193200000X MULTI-SPECIALTY GROUP		 152W00000X T03019 MO Yes

Addresses

Primary practice location

2572 Lemay Ferry Rd
Saint Louis, MO 63125-3131

Mailing address

PO Box 207158
Dallas, TX 75320-7158
Phone (636) 200-4393

Other names

  • Clarkson Eyecare Doing business as

Other providers in Saint Louis, MO

All providers in Saint Louis, MO · Optometrist in Missouri

Sources for this page

Verify at the official NPI Registry.