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NPI Code Detail

MEDICARE: CLARKSON OPTOMETRY INC

MEDICARE: CLARKSON OPTOMETRY INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist

General Provider Information

NPI Number : 1578515243
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLARKSON OPTOMETRY INC
Provider Business Mailing Address
First Line : PO BOX 207158
Second Line :
City : DALLAS
State : TX
Zip : 75320-7158
Country : US
Telephone Number : 636-200-4393
Fax Number : 636-527-0766
Provider Business Practice Location Address
First Line : 933 HIGHWAY K
Second Line :
City : O FALLON
State : MO
Zip : 63366-2910
Country : US
Telephone Number : 636-200-4393
Fax Number : 636-272-2765
Authorized Official
Title or Position : CMO
Name : JAMES WACHTER
Credential : OD
Telephone Number : 636-200-4393
Provider Enumeration Date : 05/17/2006
Last Update Date : 07/05/2019

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Directions to “CLARKSON OPTOMETRY INC ” Practice Location

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