14D2188207 CLIA NUMBER - NORTHSHORE IMMEDIATE CARE ANDERSONVILLE

Laboratory Demographics

  • CLIA Code: 14D2188207
  • Facility Name: NORTHSHORE IMMEDIATE CARE ANDERSONVILLE
  • Facility Address: 4914 N CLARK
    CHICAGO, IL
    ZIP 60640
  • Facility Phone: 224 364-2273
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AMANDA J. CAPLAN M D
  • NPI Number: 1952612111
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 14D2188207
LAB Type Physician Office
Facility Name NORTHSHORE IMMEDIATE CARE ANDERSONVILLE
Street 4914 N CLARK
City CHICAGO
State IL
ZIP 60640
Phone 224 364-2273
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/14/2024
Certificate Expiration Date 7/13/2026
Facility Type Physician Office
Lab Director AMANDA J. CAPLAN M D

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