20D2115112 CLIA NUMBER - EYE CENTER NORTHEAST

Laboratory Demographics

  • CLIA Code: 20D2115112
  • Facility Name: EYE CENTER NORTHEAST
  • Facility Address: 955 BROADWAY ATTN CHRISTIE THERAULT
    BANGOR, ME
    ZIP 04401
  • Facility Phone: 207 990-4388
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAVID T. DOUGLASS
  • NPI Number: 1467601872
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 20D2115112
LAB Type Physician Office
Facility Name EYE CENTER NORTHEAST
Street 955 BROADWAY ATTN CHRISTIE THERAULT
City BANGOR
State ME
ZIP 04401
Phone 207 990-4388
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/28/2024
Certificate Expiration Date 6/27/2026
Facility Type Physician Office
Lab Director DAVID T. DOUGLASS

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