15D2147606 CLIA NUMBER - MIDWEST EYE CONSULTANTS #17

Laboratory Demographics

  • CLIA Code: 15D2147606
  • Facility Name: MIDWEST EYE CONSULTANTS #17
  • Facility Address: 1240 MEDICAL PARK DR
    FORT WAYNE, IN
    ZIP 46825
  • Facility Phone: 260 471-2375
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ALICIA WAXLER
  • NPI Number: 1922061530
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 15D2147606
LAB Type Physician Office
Facility Name MIDWEST EYE CONSULTANTS #17
Street 1240 MEDICAL PARK DR
City FORT WAYNE
State IN
ZIP 46825
Phone 260 471-2375
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/23/2024
Certificate Expiration Date 4/22/2026
Facility Type Physician Office
Lab Director ALICIA WAXLER

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