04D2039970 CLIA NUMBER - SURGERY BY VOLD VISION

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Laboratory Demographics

CLIA Number: 04D2039970

Facility Name: SURGERY BY VOLD VISION

Facility Address:
2783 N SHILOH DRIVE
FAYETTEVILLE, AR
ZIP 72704
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Facility Phone Number: 479 756-8653

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1073888103

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	04D2039970
LAB Type	Ambulatory Surgery Center
Facility Name	SURGERY BY VOLD VISION
Street	2783 N SHILOH DRIVE
City	FAYETTEVILLE
State	AR
ZIP	72704
Phone	479 756-8653
CertificateType	4
CertificateEffectiveDate	4/20/2024
CertificateExpirationDate	4/19/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024