20D2106859 CLIA NUMBER - BANGOR EYE SURGERY

Laboratory Demographics

CLIA Number: 20D2106859

Facility Name: BANGOR EYE SURGERY

Facility Address:
900A HAMMOND STREET
BANGOR, ME
ZIP 04401
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Facility Phone Number: 207 947-6743

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1215309653

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	20D2106859
LAB Type	Ambulatory Surgery Center
Facility Name	BANGOR EYE SURGERY
Street	900A HAMMOND STREET
City	BANGOR
State	ME
ZIP	04401
Phone	207 947-6743
CertificateType	4
CertificateEffectiveDate	12/30/2023
CertificateExpirationDate	12/29/2025
FacilityType	Waiver

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