Healthcare Provider Details

I. General information

NPI: 1386697910
Provider Name (Legal Business Name): CLARKSON EYECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 11/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4575 GRAVOIS RD
HOUSE SPRINGS MO
63051-1374
US

IV. Provider business mailing address

40 E NORTH ST
EUREKA MO
63025-1205
US

V. Phone/Fax

Practice location:
  • Phone: 636-671-7272
  • Fax:
Mailing address:
  • Phone: 636-200-4393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: KRIS CALDWELL
Title or Position: MANAGER OF CENTRAL OPERATIONS
Credential:
Phone: 636-200-4393