11D2071623 CLIA NUMBER - MARIETTA EYE CLINIC, PA

Laboratory Demographics

  • CLIA Code: 11D2071623
  • Facility Name: MARIETTA EYE CLINIC, PA
  • Facility Address: 100 OLD BALL GROUND HIGHWAY SUITE A
    CANTON, GA
    ZIP 30114
  • Facility Phone: 770 479-2195
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANDRE S. COHEN
  • NPI Number: 1285797829
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 11D2071623
LAB Type Physician Office
Facility Name MARIETTA EYE CLINIC, PA
Street 100 OLD BALL GROUND HIGHWAY SUITE A
City CANTON
State GA
ZIP 30114
Phone 770 479-2195
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/16/2024
Certificate Expiration Date 1/15/2026
Facility Type Physician Office
Lab Director ANDRE S. COHEN

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