Active NPI
Clarkson Optometry Illinois PC
Doing business as Clarkson Eyecare
- Optometrist
- Red Bud, IL
National Provider Identifier
1952595878
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- Legal business name
- CLARKSON OPTOMETRY ILLINOIS PC
- Doing business as
- Clarkson Eyecare
- Practice address
- 210 S Main
Red Bud, IL 62278 - Phone
- (618) 635-3535
- Fax
- (618) 282-2830
- NPI assigned
- Sep 4, 2007
- Last updated
- Jan 31, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. James J Wachter, OD
- Title
- Cmo
- 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) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | IL | Primary |
Addresses
Primary practice location
210 S Main
Red Bud, IL 62278
Mailing address
15933 Clayton Rd Ste 201
Ballwin, MO 63011-2172
Phone (636) 200-4393
Other identifiers 11
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0460069901 | Medicaid | IL | |
| 0460089082 | Medicaid | IL | |
| 203193 | Other | PTAN | |
| 203194 | Other | PTAN | |
| 0460089501 | Medicaid | IL | |
| 203195 | Other | PTAN | |
| 046008176 | Medicaid | IL | |
| 0460078192 | Medicaid | IL | |
| 036104178 | Medicaid | IL | |
| 046006474 | Medicaid | IL | |
| 0460085471 | Medicaid | IL |
Other names 1
- Clarkson Eyecare
National Provider Directory
National Provider Directory- Tax ID family
- Clarkson Eyecare
Other organizations with this tax ID 14
Organizations that report the same tax identification number in the National Provider Directory.
-
- Optometrist
- Belleville, IL
- NPI 1124214051
-
- Optometrist
- Shiloh, IL
- NPI 1457303125
-
- Optometrist
- Columbia, IL
- NPI 1508083502
-
- Optometrist
- Staunton, IL
- NPI 1578806378
-
- Optometrist
- Edwardsville, IL
- NPI 1669668836
-
dba Clarkson Eyecare
- Durable Medical Equipment & Medical Supplies
- Granite City, IL
- NPI 1497807267
Practitioners & affiliated clinicians
Practitioners 1
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.
-
- Optometrist
- Ellisville, MO
- NPI 1689670697
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1188864000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1517356800000",
"number": "1952595878",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15933 CLAYTON RD STE 201",
"city": "BALLWIN",
"state": "MO",
"postal_code": "630112172",
"telephone_number": "636-200-4393",
"fax_number": "636-527-0766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 S MAIN",
"city": "RED BUD",
"state": "IL",
"postal_code": "62278",
"telephone_number": "618-635-3535",
"fax_number": "618-282-2830"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CLARKSON OPTOMETRY ILLINOIS PC",
"organizational_subpart": "NO",
"enumeration_date": "2007-09-04",
"last_updated": "2018-01-31",
"status": "A",
"authorized_official_last_name": "WACHTER",
"authorized_official_first_name": "JAMES",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "CMO",
"authorized_official_telephone_number": "636-200-4393",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "OD"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0460069901",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0460089082",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTAN",
"identifier": "203193",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTAN",
"identifier": "203194",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0460089501",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTAN",
"identifier": "203195",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "046008176",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0460078192",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036104178",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "046006474",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0460085471",
"state": "IL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Clarkson Eyecare",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Red Bud, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.