05D1073861 CLIA NUMBER - RETINAL DIAGNOSTIC CENTER

Laboratory Demographics

CLIA Number: 05D1073861

Facility Name: RETINAL DIAGNOSTIC CENTER

Facility Address:
3395 S BASCOM AVE STE 140
CAMPBELL, CA
ZIP 95008
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Facility Phone Number: 408 559-0666

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1518030568

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	05D1073861
LAB Type	Physician Office
Facility Name	RETINAL DIAGNOSTIC CENTER
Street	3395 S BASCOM AVE STE 140
City	CAMPBELL
State	CA
ZIP	95008
Phone	408 559-0666
CertificateType	4
CertificateEffectiveDate	9/18/2023
CertificateExpirationDate	9/17/2025
FacilityType	Waiver

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