17D2215236 CLIA NUMBER - MAYDEW THIBAULT OPTOMETRY LLC

Laboratory Demographics

  • CLIA Code: 17D2215236
  • Facility Name: MAYDEW THIBAULT OPTOMETRY LLC
  • Facility Address: 216 SOUTH OAK
    PRATT, KS
    ZIP 67124
  • Facility Phone: 620 672-5934
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: SETH A. THIBAULT
  • NPI Number: 1356638662
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 17D2215236
LAB Type Practitioner Other
Facility Name MAYDEW THIBAULT OPTOMETRY LLC
Street 216 SOUTH OAK
City PRATT
State KS
ZIP 67124
Phone 620 672-5934
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/2/2025
Certificate Expiration Date 3/1/2027
Facility Type Practitioner Other
Lab Director SETH A. THIBAULT

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