14D2015913 CLIA NUMBER - JACKSON EYE SC

Laboratory Demographics

  • CLIA Code: 14D2015913
  • Facility Name: JACKSON EYE SC
  • Facility Address: 300 N MILWAUKEE AVE STE L
    LAKE VILLA, IL
    ZIP 60046
  • Facility Phone: 847 356-0700
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MITCHELL A. JACKSON M D
  • NPI Number: 1073669834
  • Taxonomy: 207W00000X - Ophthalmology

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CLIA Record

Field Name Field Value
CLIA Number 14D2015913
LAB Type Physician Office
Facility Name JACKSON EYE SC
Street 300 N MILWAUKEE AVE STE L
City LAKE VILLA
State IL
ZIP 60046
Phone 847 356-0700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/9/2024
Certificate Expiration Date 2/8/2026
Facility Type Physician Office
Lab Director MITCHELL A. JACKSON M D

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