CLARKSON OPTOMETRY ILLINOIS PC — NPI 1457303125 (Licensed & Credentialed Eye and Vision Service Providers

CMS-1500 Box 24J / 33a • NPI

1457303125

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

152W00000X (CMS 41)

Licensed & Credentialed Eye and Vision Service Providers — Optometrist

Box 32 Service Location & ZIP+4

3248 GREEN MOUNT CROSSING DR, SHILOH, IL, 62269-7284

✓ 9-Digit EDI 837 ZIP+4 (62269-7284)

Practice Phone & Referral Fax

(636) 200-4393

Fax: (618) 624-6731

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1457303125 (CLARKSON OPTOMETRY ILLINOIS PC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1457303125` (NPI-2 Organization / Facility)
Provider / Legal Name	CLARKSON OPTOMETRY ILLINOIS PC
Plain-English Specialty	Licensed & Credentialed Eye and Vision Service Providers — Optometrist NUCC Code: `152W00000X` (Optometrist)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	3248 GREEN MOUNT CROSSING DR, SHILOH, IL, 62269-7284
Practice Telephone / Fax	Tel: (636) 200-4393 \| Fax: (618) 624-6731
Administrative Mailing Address	PO BOX 207163, DALLAS, TX, 75320-7154
Enumeration & Last Sync	Enumerated: 2006-05-17 \| CMS Record Updated: 2019-06-21
Authorized Official	JAMES WACHTER (CMO)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

3248 GREEN MOUNT CROSSING DR, SHILOH, IL, 62269-7284

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Plain-English Taxonomy & CMS Crosswalk (152W00000X)

What Does Taxonomy Code 152W00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 152W00000X translates to:
"Licensed & Credentialed Eye and Vision Service Providers — Optometrist"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 41 (Optometry)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Optometrist for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (CLARKSON OPTOMETRY ILLINOIS PC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`152W00000X` — Optometrist Plain English: Licensed & Credentialed Eye and Vision Service Providers — Optometrist	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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CLARKSON OPTOMETRY ILLINOIS PC (NPI #1457303125)