14D2089553 CLIA NUMBER - PEDIATRIC AND ADOLESCENT HEALTHY LIFESTYLE CTR

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Laboratory Demographics

CLIA Number: 14D2089553

Facility Name: PEDIATRIC AND ADOLESCENT HEALTHY LIFESTYLE CTR

Facility Address:
2525 OGDEN AVE
DOWNERS GROVE, IL
ZIP 60515
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Facility Phone Number: 630 929-3009

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1790989705

Taxonomy: 207W00000X - Ophthalmology
An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses.

CLIA Record

Field Name	Field Value
CLIA Number	14D2089553
LAB Type	Physician Office
Facility Name	PEDIATRIC AND ADOLESCENT HEALTHY LIFESTYLE CTR
Street	2525 OGDEN AVE
City	DOWNERS GROVE
State	IL
ZIP	60515
Phone	630 929-3009
CertificateType	4
CertificateEffectiveDate	1/5/2023
CertificateExpirationDate	1/4/2025
FacilityType	Waiver

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