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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

NPI # 1063606978
LBN Legal business name CLARKSON OPTOMETRY ILLINOIS PC
Authorized official JAMES WACHTER - (CMO)
Entity Organization
Organization subpart 1 No
Enumeration date 09/04/2007
Last updated 06/21/2019 - About 7 years ago
Identifiers
IL License # 036104178
IL Medicaid 036104178
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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