16D2111595 CLIA NUMBER - EYEWEAR GALLERY LLC

Laboratory Demographics

  • CLIA Code: 16D2111595
  • Facility Name: EYEWEAR GALLERY LLC
  • Facility Address: 2407 12TH ST CT
    DEWITT, IA
    ZIP 52742
  • Facility Phone: 563 659-2020
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: JACOB M. HAYWARD
  • NPI Number: 1588029938
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 16D2111595
LAB Type Practitioner Other
Facility Name EYEWEAR GALLERY LLC
Street 2407 12TH ST CT
City DEWITT
State IA
ZIP 52742
Phone 563 659-2020
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/11/2024
Certificate Expiration Date 4/10/2026
Facility Type Practitioner Other
Lab Director JACOB M. HAYWARD

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