14D2064975 CLIA NUMBER - BUENA VISTA OPTICAL P C

Laboratory Demographics

  • CLIA Code: 14D2064975
  • Facility Name: BUENA VISTA OPTICAL P C
  • Facility Address: 6455 S KEDZIE AVE
    CHICAGO, IL
    ZIP 60629
  • Facility Phone: 773 863-9234
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: TODD SIMS O D
  • NPI Number: 1740464296
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2064975
LAB Type Practitioner Other
Facility Name BUENA VISTA OPTICAL P C
Street 6455 S KEDZIE AVE
City CHICAGO
State IL
ZIP 60629
Phone 773 863-9234
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/30/2025
Certificate Expiration Date 8/29/2027
Facility Type Practitioner Other
Lab Director TODD SIMS O D

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