10D1100336 CLIA NUMBER - PROVISION LASER EYE CENTER

Laboratory Demographics

  • CLIA Code: 10D1100336
  • Facility Name: PROVISION LASER EYE CENTER
  • Facility Address: 1191 JACARANDA BLVD
    VENICE, FL
    ZIP 34292
  • Facility Phone: 941 493-0311
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SCOTT DURRETT
  • NPI Number: 1184616146
  • Taxonomy: 207W00000X - Ophthalmology

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CLIA Record

Field Name Field Value
CLIA Number 10D1100336
LAB Type Physician Office
Facility Name PROVISION LASER EYE CENTER
Street 1191 JACARANDA BLVD
City VENICE
State FL
ZIP 34292
Phone 941 493-0311
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/4/2025
Certificate Expiration Date 6/3/2027
Facility Type Physician Office
Lab Director SCOTT DURRETT

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