Healthcare Provider Details

I. General information

NPI: 1366332777
Provider Name (Legal Business Name): CLARKSON OPTOMETRY MIDWEST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9525 KENWOOD RD
BLUE ASH OH
45242-6176
US

IV. Provider business mailing address

15933 CLAYTON RD
BALLWIN MO
63011-2198
US

V. Phone/Fax

Practice location:
  • Phone: 513-891-4121
  • Fax: 513-891-4179
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: JAMES WACHTER
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 636-200-4393