13D0976451 CLIA NUMBER - EAGLE EYE SURGERY AND LASER CENTER

Laboratory Demographics

CLIA Number: 13D0976451

Facility Name: EAGLE EYE SURGERY AND LASER CENTER

Facility Address:
3090 E GENTRY WAY #100
MERIDIAN, ID
ZIP 83642
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Facility Phone Number: 208 288-1600

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1235255605

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D0976451
LAB Type	Ambulatory Surgery Center
Facility Name	EAGLE EYE SURGERY AND LASER CENTER
Street	3090 E GENTRY WAY #100
City	MERIDIAN
State	ID
ZIP	83642
Phone	208 288-1600
CertificateType	4
CertificateEffectiveDate	8/4/2022
CertificateExpirationDate	8/3/2024
FacilityType	Waiver

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