20D2201053 CLIA NUMBER - RIVERSIDE EYE CENTER, PA DBA RIVERSIDE EYE SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 20D2201053
  • Facility Name: RIVERSIDE EYE CENTER, PA DBA RIVERSIDE EYE SURGERY CENTER
  • Facility Address: 475 LISBON ST
    LEWISTON, ME
    ZIP 04240
  • Facility Phone: 207 786-2500
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: MARTIN D. WHITAKER
  • NPI Number: 1467157784
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 20D2201053
LAB Type Practitioner Other
Facility Name RIVERSIDE EYE CENTER, PA DBA RIVERSIDE EYE SURGERY CENTER
Street 475 LISBON ST
City LEWISTON
State ME
ZIP 04240
Phone 207 786-2500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/18/2024
Certificate Expiration Date 11/17/2026
Facility Type Practitioner Other
Lab Director MARTIN D. WHITAKER

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This page was last updated on: 6/4/2025