11D2135810 CLIA NUMBER - MARIETTA EYE CLINIC, PA

Laboratory Demographics

CLIA Number: 11D2135810

Facility Name: MARIETTA EYE CLINIC, PA

Facility Address:
2990 EAGLE DRIVE, SUITE 110
WOODSTOCK, GA
ZIP 30189
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Facility Phone Number: 678 460-4810

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1336664226

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	11D2135810
LAB Type	Physician Office
Facility Name	MARIETTA EYE CLINIC, PA
Street	2990 EAGLE DRIVE, SUITE 110
City	WOODSTOCK
State	GA
ZIP	30189
Phone	678 460-4810
CertificateType	4
CertificateEffectiveDate	8/29/2023
CertificateExpirationDate	8/28/2025
FacilityType	Waiver

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