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General NPI Number Information
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NPI Number | 1548272636
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Entity Type | Organization
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Legal Business Name | CLARKSON OPTOMETRY MIDWEST INC
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 5283 CORNERSTONE NORTH BLVD
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City | CENTERVILLE
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State | OH
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Zip | 45440-2270
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Country | US
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Telephone | 693-784-8660
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Fax | 937-848-6101
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Provider Business Mailing Address
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Address Line | PO BOX 207170
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City | DALLAS
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State | TX
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Zip | 75320-7156
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Country | US
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Telephone | 636-200-4393
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Fax | 636-527-0766
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Authorized Official
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Title or Position | CMO
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Name | JAMES WACHTER
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Credential |
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Telephone | 636-200-4393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4141
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License Number State | OH
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