Organization
CLARKSON OPTOMETRY ILLINOIS, P.C.
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
408 W 2ND ST, CENTRALIA, IL 62801-3402
(636) 200-4393
(618) 532-6706
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
036104178
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036104178
—
IL
Enumeration date
09/04/2007
Last updated
06/06/2019
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