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Contact Information

CLARKSON OPTOMETRY ILLINOIS PC
103 CLINTONIAN PLAZA
BREESE, IL62230
 Phone: 636-200-4393
 Fax: 618-526-7455
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for CLARKSON OPTOMETRY ILLINOIS PC · (Female)

NPI Number 1063606978
Status Active
Credentials
Entity Individual
Enumeration date 09/04/2007
Last updated 06/21/2019 - About 7 years ago
Sole proprietor 1 Not specified
Identifiers
  • IL License # 036104178
  • IL Medicaid 036104178
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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