13D2026988 CLIA NUMBER - HAYDEN VISION SOURCE

Laboratory Demographics

  • CLIA Code: 13D2026988
  • Facility Name: HAYDEN VISION SOURCE
  • Facility Address: 8445 N GOVERNMENT WAY
    HAYDEN, ID
    ZIP 83835
  • Facility Phone: 208 772-3208
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROBERT A. SORENSEN
  • NPI Number: 1629427372
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 13D2026988
LAB Type Physician Office
Facility Name HAYDEN VISION SOURCE
Street 8445 N GOVERNMENT WAY
City HAYDEN
State ID
ZIP 83835
Phone 208 772-3208
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/14/2023
Certificate Expiration Date 7/13/2025
Facility Type Physician Office
Lab Director ROBERT A. SORENSEN

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This page was last updated on: 3/20/2025