15D2120073 CLIA NUMBER - FOUNTAIN SQUARE EYE CARE

Laboratory Demographics

  • CLIA Code: 15D2120073
  • Facility Name: FOUNTAIN SQUARE EYE CARE
  • Facility Address: 1429 SHELBY ST
    INDIANAPOLIS, IN
    ZIP 46203
  • Facility Phone: 317 632-9220
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RAJENDER MACHA
  • NPI Number: 1043614027
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 15D2120073
LAB Type Physician Office
Facility Name FOUNTAIN SQUARE EYE CARE
Street 1429 SHELBY ST
City INDIANAPOLIS
State IN
ZIP 46203
Phone 317 632-9220
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/11/2024
Certificate Expiration Date 10/10/2026
Facility Type Physician Office
Lab Director RAJENDER MACHA

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