04D2023634 CLIA NUMBER - ENNEN EYE CENTER

Laboratory Demographics

  • CLIA Code: 04D2023634
  • Facility Name: ENNEN EYE CENTER
  • Facility Address: 3312 SOUTH 70TH STREET
    FORT SMITH, AR
    ZIP 72903
  • Facility Phone: 479 452-7800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RANDY M. ENNEN
  • NPI Number: 1003877150
  • Taxonomy: 207W00000X - Ophthalmology

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CLIA Record

Field Name Field Value
CLIA Number 04D2023634
LAB Type Physician Office
Facility Name ENNEN EYE CENTER
Street 3312 SOUTH 70TH STREET
City FORT SMITH
State AR
ZIP 72903
Phone 479 452-7800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/28/2025
Certificate Expiration Date 4/27/2027
Facility Type Physician Office
Lab Director RANDY M. ENNEN

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