10D2010984 CLIA NUMBER - TAD R KOSANOVICH OD PA

Laboratory Demographics

  • CLIA Code: 10D2010984
  • Facility Name: TAD R KOSANOVICH OD PA
  • Facility Address: 150 S INDIANA AVE
    ENGLEWOOD, FL
    ZIP 34223
  • Facility Phone: 941 473-1392
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TAD KOSANOVICH
  • NPI Number: 1285785527
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 10D2010984
LAB Type Physician Office
Facility Name TAD R KOSANOVICH OD PA
Street 150 S INDIANA AVE
City ENGLEWOOD
State FL
ZIP 34223
Phone 941 473-1392
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/10/2024
Certificate Expiration Date 8/9/2026
Facility Type Physician Office
Lab Director TAD KOSANOVICH

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