21D2175360 CLIA NUMBER - LEXINGTON PARK CBOC

Laboratory Demographics

  • CLIA Code: 21D2175360
  • Facility Name: LEXINGTON PARK CBOC
  • Facility Address: 45870 EAST RUN BOULEVARD
    LEXINGTON PARK, MD
    ZIP 20653
  • Facility Phone: 240 237-1625
  • Facility Type: Community Clinic
  • Facility Type: Accreditation
  • Lab Director: JACK LICHY
  • NPI Number: 1477673879
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 21D2175360
LAB Type Community Clinic
Facility Name LEXINGTON PARK CBOC
Street 45870 EAST RUN BOULEVARD
City LEXINGTON PARK
State MD
ZIP 20653
Phone 240 237-1625
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 11/20/2019
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