05D2103523 CLIA NUMBER - GLENDALE EYE MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 05D2103523
  • Facility Name: GLENDALE EYE MEDICAL GROUP
  • Facility Address: 500 N CENTRAL AVE STE 100
    GLENDALE, CA
    ZIP 91203
  • Facility Phone: 818 956-1010
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RICHARD A. WEISE, MD
  • NPI Number: 1225001423
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2103523
LAB Type Physician Office
Facility Name GLENDALE EYE MEDICAL GROUP
Street 500 N CENTRAL AVE STE 100
City GLENDALE
State CA
ZIP 91203
Phone 818 956-1010
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/14/2023
Certificate Expiration Date 10/13/2025
Facility Type Physician Office
Lab Director RICHARD A. WEISE, MD

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