21D2153774 CLIA NUMBER - MONTGOMERY COUNTY CBOC

Laboratory Demographics

  • CLIA Code: 21D2153774
  • Facility Name: MONTGOMERY COUNTY CBOC
  • Facility Address: 15810 GAITHER DRIVE
    GAITHERSBURG, MD
    ZIP 20877
  • Facility Phone: 202 745-8285
  • Facility Type: Community Clinic
  • Facility Type: Accreditation
  • Lab Director: JACK LICHY
  • NPI Number: 1184633257
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 21D2153774
LAB Type Community Clinic
Facility Name MONTGOMERY COUNTY CBOC
Street 15810 GAITHER DRIVE
City GAITHERSBURG
State MD
ZIP 20877
Phone 202 745-8285
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 8/29/2018
Certificate Expiration Date 5/22/2026
Facility Type Community Clinic
Lab Director JACK LICHY

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