03D2253722 CLIA NUMBER - PRIMARY EYE CARE CENTER OF AHWATUKEE, PLC

Laboratory Demographics

  • CLIA Code: 03D2253722
  • Facility Name: PRIMARY EYE CARE CENTER OF AHWATUKEE, PLC
  • Facility Address: 16515 S 40TH ST STE 111
    PHOENIX, AZ
    ZIP 85048
  • Facility Phone: 480 706-2020
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JENNA M. DERUBEIS
  • NPI Number: 1477166379
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 03D2253722
LAB Type Physician Office
Facility Name PRIMARY EYE CARE CENTER OF AHWATUKEE, PLC
Street 16515 S 40TH ST STE 111
City PHOENIX
State AZ
ZIP 85048
Phone 480 706-2020
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/23/2024
Certificate Expiration Date 2/22/2026
Facility Type Physician Office
Lab Director JENNA M. DERUBEIS

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This page was last updated on: 3/20/2025