10D2303531 CLIA NUMBER - COASTAL VISION CENTER

Laboratory Demographics

  • CLIA Code: 10D2303531
  • Facility Name: COASTAL VISION CENTER
  • Facility Address: 2416 LYNNDALE RD SUITE 201
    FERNANDINA BEACH, FL
    ZIP 32034
  • Facility Phone: 904 261-5741
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RUSSELL STACKHOUSE
  • NPI Number: 1538655014
  • Taxonomy: 207W00000X - Ophthalmology

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CLIA Record

Field Name Field Value
CLIA Number 10D2303531
LAB Type Physician Office
Facility Name COASTAL VISION CENTER
Street 2416 LYNNDALE RD SUITE 201
City FERNANDINA BEACH
State FL
ZIP 32034
Phone 904 261-5741
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/26/2024
Certificate Expiration Date 4/25/2026
Facility Type Physician Office
Lab Director RUSSELL STACKHOUSE

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