10D1107441 CLIA NUMBER - FORT MYERS EYE SURGERY CENTER LLC

Laboratory Demographics

CLIA Number: 10D1107441

Facility Name: FORT MYERS EYE SURGERY CENTER LLC

Facility Address:
4790 BARKLEY CIR, BLDG C, STE 101
FORT MYERS, FL
ZIP 33907
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Facility Phone Number: 239 277-1778

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1437482924

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D1107441
LAB Type	Ambulatory Surgery Center
Facility Name	FORT MYERS EYE SURGERY CENTER LLC
Street	4790 BARKLEY CIR, BLDG C, STE 101
City	FORT MYERS
State	FL
ZIP	33907
Phone	239 277-1778
CertificateType	4
CertificateEffectiveDate	11/5/2023
CertificateExpirationDate	11/4/2025
FacilityType	Waiver

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