05D2110624 CLIA NUMBER - CALIFORNIA RETINA CONSULTANTS

Laboratory Demographics

CLIA Number: 05D2110624

Facility Name: CALIFORNIA RETINA CONSULTANTS

Facility Address:
1510 E MAIN ST STE 103
SANTA MARIA, CA
ZIP 93454
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Facility Phone Number: 805 922-2068

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1265575591

Taxonomy: 207WX0107X - Ophthalmology
An ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases.

CLIA Record

Field Name	Field Value
CLIA Number	05D2110624
LAB Type	Physician Office
Facility Name	CALIFORNIA RETINA CONSULTANTS
Street	1510 E MAIN ST STE 103
City	SANTA MARIA
State	CA
ZIP	93454
Phone	805 922-2068
CertificateType	4
CertificateEffectiveDate	3/21/2024
CertificateExpirationDate	3/20/2026
FacilityType	Waiver

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