Organization
CLARKSON OPTOMETRY ILLINOIS PC
Active
Other names
Clarkson Eyecare
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES J WACHTER OD (CMO)
(636) 200-4393
Entity
Organization
Contact information
Practice address
210 S MAIN, RED BUD, IL 62278
(618) 635-3535
(618) 282-2830
Mailing address
15933 CLAYTON RD STE 201, BALLWIN, MO 63011-2172
(636) 200-4393
(636) 527-0766
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036104178
—
IL
05
—
046006474
—
IL
05
—
0460069901
—
IL
05
—
0460078192
—
IL
05
—
046008176
—
IL
05
—
0460085471
—
IL
05
—
0460089082
—
IL
05
—
0460089501
—
IL
01
—
203193
PTAN
—
01
—
203194
PTAN
—
01
—
203195
PTAN
—
Enumeration date
09/04/2007
Last updated
01/31/2018
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