Organization
CLARKSON OPTOMETRY ILLINOIS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES J WACHTER OD (CMO)
(636) 200-4393
Entity
Organization
Contact information
Practice address
2525 GREEN MOUNT CROSSING DR., SUITE 290, BELLEVILLE, IL 62221-6735
(636) 200-4393
(618) 233-7290
Mailing address
PO BOX 207163, DALLAS, TX 75320-7154
(636) 200-4393
(636) 527-0766
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0046.009944
IL
Other
Enumeration date
09/25/2007
Last updated
06/21/2019
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