14D2319266 CLIA NUMBER - RETINAL VITREAL CONSULTANTS

Laboratory Demographics

  • CLIA Code: 14D2319266
  • Facility Name: RETINAL VITREAL CONSULTANTS
  • Facility Address: 2600 S MICHIGAN AVE - STE 212
    CHICAGO, IL
    ZIP 60616
  • Facility Phone: 312 567-2795
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SHAUN ITTIARA
  • NPI Number: 1164569380
  • Taxonomy: 207W00000X - Ophthalmology

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CLIA Record

Field Name Field Value
CLIA Number 14D2319266
LAB Type Physician Office
Facility Name RETINAL VITREAL CONSULTANTS
Street 2600 S MICHIGAN AVE - STE 212
City CHICAGO
State IL
ZIP 60616
Phone 312 567-2795
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/26/2025
Certificate Expiration Date 2/25/2027
Facility Type Physician Office
Lab Director SHAUN ITTIARA

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