21D2308853 CLIA NUMBER - SEVERNA PARK EYE CARE

Laboratory Demographics

  • CLIA Code: 21D2308853
  • Facility Name: SEVERNA PARK EYE CARE
  • Facility Address: 139 RITCHIE HWY #B
    SEVERNA PARK, MD
    ZIP 21146
  • Facility Phone: 410 544-7417
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: DR. SHAWN M. MUDD
  • NPI Number: 1528183191
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 21D2308853
LAB Type Practitioner Other
Facility Name SEVERNA PARK EYE CARE
Street 139 RITCHIE HWY #B
City SEVERNA PARK
State MD
ZIP 21146
Phone 410 544-7417
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/6/2024
Certificate Expiration Date 8/5/2026
Facility Type Practitioner Other
Lab Director DR. SHAWN M. MUDD

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