14D2094022 CLIA NUMBER - CLARKSON OPTOMETRY ILLINOIS, PC

Laboratory Demographics

  • CLIA Code: 14D2094022
  • Facility Name: CLARKSON OPTOMETRY ILLINOIS, PC
  • Facility Address: 103 CLINTONIAN PLAZA
    BREESE, IL
    ZIP 62230
  • Facility Phone: 618 526-7447
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAMES WACHTER OD
  • NPI Number: 1063606978
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 14D2094022
LAB Type Physician Office
Facility Name CLARKSON OPTOMETRY ILLINOIS, PC
Street 103 CLINTONIAN PLAZA
City BREESE
State IL
ZIP 62230
Phone 618 526-7447
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/8/2025
Certificate Expiration Date 4/7/2027
Facility Type Physician Office
Lab Director JAMES WACHTER OD

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This page was last updated on: 9/29/2025