05D2294038 CLIA NUMBER - MACULA RETINA VITREOUS RESEARCH INSTITUTE

Laboratory Demographics

  • CLIA Code: 05D2294038
  • Facility Name: MACULA RETINA VITREOUS RESEARCH INSTITUTE
  • Facility Address: 20528 HAWTHORNE BLVD, SUITE 302
    TORRANCE, CA
    ZIP 90503
  • Facility Phone: 949 394-1524
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MEHRAN TABAN
  • NPI Number: 1104221035
  • Taxonomy: 207W00000X - Ophthalmology

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CLIA Record

Field Name Field Value
CLIA Number 05D2294038
LAB Type Physician Office
Facility Name MACULA RETINA VITREOUS RESEARCH INSTITUTE
Street 20528 HAWTHORNE BLVD, SUITE 302
City TORRANCE
State CA
ZIP 90503
Phone 949 394-1524
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/17/2023
Certificate Expiration Date 11/16/2025
Facility Type Physician Office
Lab Director MEHRAN TABAN

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