Organization
CLARKSON OPTOMETRY MIDWEST INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES WACHTER (OWNER)
(636) 200-4393
Entity
Organization
Contact information
Practice address
109 W 5TH ST, BENTON, KY 42025-1123
(636) 200-4393
Mailing address
PO BOX 207170, DALLAS, TX 75320-7156
(636) 200-4393
(636) 527-0766
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1073DT
KY
152W00000X
Optometrist
1469DT
KY
152W00000X
Optometrist
1767DT
KY
Other
Enumeration date
08/22/2007
Last updated
07/08/2019
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