Organization
CLARKSON OPTOMETRY ILLINOIS PC
Active
Other names
Clarkson Eyecare, Clarkson Eye Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES J WACHTER OD (CMO)
(636) 200-4393
Entity
Organization
Contact information
Practice address
3000 BROADWAY ST, MOUNT VERNON, IL 62864-2340
(636) 200-4393
(618) 242-4192
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036104178
—
IL
Enumeration date
08/29/2007
Last updated
06/21/2019
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