CLARKSON EYECARE INC

Provider Demographics

• NPI: 1780643304
• Name: CLARKSON EYECARE INC
• Entity Type: Organization
• Organization Name: CLARKSON EYECARE INC
• Authorized Official - Title/Position: DIRECTOR OF CENTRAL OPERATIONS
• Authorized Official - First Name: KRIS
• Authorized Official - Last Name: CALDWELL
• Authorized Official - Phone: 636-200-4393
• Mailing Address - Street 1: 40 E NORTH ST
• Mailing Address - City: EUREKA
• Mailing Address - State: MO
• Mailing Address - Zip Code: 63025-1205
• Mailing Address - Country: US
• Practice Address - Street 1: 40 E NORTH ST
• Practice Address - City: EUREKA
• Practice Address - State: MO
• Practice Address - Zip Code: 63025-1205
• Practice Address - Country: US
• Practice Address - Phone: 636-200-4393
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-03-22
• Last Update Date: 2019-06-06

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	152W00000X	Eye and Vision Services Providers	Optometrist		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
	0360070002	Medicare NSC
	0360070007	Medicare NSC
	0360070024	Medicare NSC
	0360070027	Medicare NSC
	0360070030	Medicare NSC
MO	0360070003	Medicare NSC
	0360070006	Medicare NSC
	0360070014	Medicare NSC
MO	0360070001	Medicare NSC
	0360070009	Medicare NSC
	0360070012	Medicare NSC
	0360070031	Medicare NSC
	0360070010	Medicare NSC
	0360070020	Medicare NSC
	0360070029	Medicare NSC
MO	000006438	Medicare ID - Type Unspecified
	0360070008	Medicare NSC
	0360070015	Medicare NSC
	0360070017	Medicare NSC
	0360070019	Medicare NSC
	0360070025	Medicare NSC
	0360070026	Medicare NSC
	0360070028	Medicare NSC
	0360070018	Medicare NSC
	0360070011	Medicare NSC
	0360070016	Medicare NSC
	0360070004	Medicare NSC
	0360070013	Medicare NSC
	0360070021	Medicare NSC
	0360070023	Medicare NSC