21D0987016 CLIA NUMBER - MARYLAND EYE SURGERY CENTER LLC

Laboratory Demographics

CLIA Number: 21D0987016

Facility Name: MARYLAND EYE SURGERY CENTER LLC

Facility Address:
800 PRINCE FREDERICK BLVD
PRINCE FREDERICK, MD
ZIP 20678
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Facility Phone Number: 410 535-9425

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1255347050

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D0987016
LAB Type	Ambulatory Surgery Center
Facility Name	MARYLAND EYE SURGERY CENTER LLC
Street	800 PRINCE FREDERICK BLVD
City	PRINCE FREDERICK
State	MD
ZIP	20678
Phone	410 535-9425
CertificateType	4
CertificateEffectiveDate	5/25/2023
CertificateExpirationDate	5/24/2025
FacilityType	Waiver

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