05D2065025 CLIA NUMBER - SUTTER GOULD MEDICAL FOUNDATION-SYLVAN EYE CENTER

Laboratory Demographics

  • CLIA Code: 05D2065025
  • Facility Name: SUTTER GOULD MEDICAL FOUNDATION-SYLVAN EYE CENTER
  • Facility Address: 1011 SYLVAN AVE STE C
    MODESTO, CA
    ZIP 95350
  • Facility Phone: 209 550-4780
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOHN A. LATHAM
  • NPI Number: 1801843750
  • Taxonomy: 207W00000X - Ophthalmology

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CLIA Record

Field Name Field Value
CLIA Number 05D2065025
LAB Type Physician Office
Facility Name SUTTER GOULD MEDICAL FOUNDATION-SYLVAN EYE CENTER
Street 1011 SYLVAN AVE STE C
City MODESTO
State CA
ZIP 95350
Phone 209 550-4780
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/11/2024
Certificate Expiration Date 9/10/2026
Facility Type Physician Office
Lab Director JOHN A. LATHAM

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