18D0985968 CLIA NUMBER - COMMONWEALTH EYE CLINIC, INC

Laboratory Demographics

CLIA Number: 18D0985968

Facility Name: COMMONWEALTH EYE CLINIC, INC

Facility Address:
2353 ALEXANDRIA DRIVE SUITE 325
LEXINGTON, KY
ZIP 40504
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Facility Phone Number: 859 219-1188

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1144806373

Taxonomy: 332BC3200X - Durable Medical Equipment & Medical Supplies

CLIA Record

Field Name	Field Value
CLIA Number	18D0985968
LAB Type	Ambulatory Surgery Center
Facility Name	COMMONWEALTH EYE CLINIC, INC
Street	2353 ALEXANDRIA DRIVE SUITE 325
City	LEXINGTON
State	KY
ZIP	40504
Phone	859 219-1188
CertificateType	4
CertificateEffectiveDate	5/3/2023
CertificateExpirationDate	5/2/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024