05D2077746 CLIA NUMBER - ELK GROVE OPTOMETRY A PROFESSIONAL CORPORATION

Laboratory Demographics

  • CLIA Code: 05D2077746
  • Facility Name: ELK GROVE OPTOMETRY A PROFESSIONAL CORPORATION
  • Facility Address: 9401 E STOCKTON BLVD STE 105
    ELK GROVE, CA
    ZIP 95624
  • Facility Phone: 916 686-4937
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: DAVID T. KAGEYAMA, OD
  • NPI Number: 1306895545
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 05D2077746
LAB Type Practitioner Other
Facility Name ELK GROVE OPTOMETRY A PROFESSIONAL CORPORATION
Street 9401 E STOCKTON BLVD STE 105
City ELK GROVE
State CA
ZIP 95624
Phone 916 686-4937
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/14/2024
Certificate Expiration Date 5/13/2026
Facility Type Practitioner Other
Lab Director DAVID T. KAGEYAMA, OD

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