15D2147608 CLIA NUMBER - MIDWEST EYE CONSULTANTS - FORT WAYNE COLISEUM #7

Laboratory Demographics

  • CLIA Code: 15D2147608
  • Facility Name: MIDWEST EYE CONSULTANTS - FORT WAYNE COLISEUM #7
  • Facility Address: 431 W COLISEUM BLVD
    FORT WAYNE, IN
    ZIP 46805
  • Facility Phone: 260 484-8516
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ALICIA R. SWANK
  • NPI Number: 1578526182
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 15D2147608
LAB Type Physician Office
Facility Name MIDWEST EYE CONSULTANTS - FORT WAYNE COLISEUM #7
Street 431 W COLISEUM BLVD
City FORT WAYNE
State IN
ZIP 46805
Phone 260 484-8516
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 R. SWANK

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