21D2306045 CLIA NUMBER - CANTON CROSSING OPTOMETRY LLC

Laboratory Demographics

  • CLIA Code: 21D2306045
  • Facility Name: CANTON CROSSING OPTOMETRY LLC
  • Facility Address: 3715 BOSTON STREET
    BALTIMORE, MD
    ZIP 21224
  • Facility Phone: 703 847-8899
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. VINCENT A. BERTOMEU
  • NPI Number: 1326474263
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 21D2306045
LAB Type Physician Office
Facility Name CANTON CROSSING OPTOMETRY LLC
Street 3715 BOSTON STREET
City BALTIMORE
State MD
ZIP 21224
Phone 703 847-8899
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/11/2024
Certificate Expiration Date 6/10/2026
Facility Type Physician Office
Lab Director DR. VINCENT A. BERTOMEU

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