02D2052513 CLIA NUMBER - WEST VALLEY VISION CENTER, INC

Laboratory Demographics

  • CLIA Code: 02D2052513
  • Facility Name: WEST VALLEY VISION CENTER, INC
  • Facility Address: 4169 GEIST RD
    FAIRBANKS, AK
    ZIP 99709
  • Facility Phone: 907 479-4700
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. MICHAEL MAVENCAMP
  • NPI Number: 1235354515
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 02D2052513
LAB Type Physician Office
Facility Name WEST VALLEY VISION CENTER, INC
Street 4169 GEIST RD
City FAIRBANKS
State AK
ZIP 99709
Phone 907 479-4700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/11/2025
Certificate Expiration Date 1/10/2027
Facility Type Physician Office
Lab Director DR. MICHAEL MAVENCAMP

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