Organization
CLARKSON OPTOMETRY INC
Active
Other names
Clarkson Eyecare
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES WACHTER (CMO)
(636) 200-4393
Entity
Organization
Contact information
Practice address
6313 RONALD REAGAN BLVD, LAKE SAINT LOUIS, MO 63367-2659
(636) 200-4393
(636) 561-2362
Mailing address
PO BOX 207158, DALLAS, TX 75320-7158
(636) 200-4393
(636) 527-0766
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000014545
MEDICARE PTAN
MO
Enumeration date
06/29/2010
Last updated
07/05/2019
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