17D2111174 CLIA NUMBER - ICT EYE, LLC

Laboratory Demographics

  • CLIA Code: 17D2111174
  • Facility Name: ICT EYE, LLC
  • Facility Address: 9300 E 29TH ST #315
    WICHITA, KS
    ZIP 67226
  • Facility Phone: (316) 425-0445
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JENNIFER K. BURGOYNE DECHANT MD
  • NPI Number: 1427446178
  • Taxonomy: 207W00000X - Ophthalmology

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CLIA Record

Field Name Field Value
CLIA Number 17D2111174
LAB Type Physician Office
Facility Name ICT EYE, LLC
Street 9300 E 29TH ST #315
City WICHITA
State KS
ZIP 67226
Phone 3164250445
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/31/2026
Certificate Expiration Date 3/30/2028
Facility Type Physician Office
Lab Director JENNIFER K. BURGOYNE DECHANT MD

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This page was last updated on: 5/15/2026