23D1090689 CLIA NUMBER - GREAT LAKES EYE CARE

Laboratory Demographics

CLIA Number: 23D1090689

Facility Name: GREAT LAKES EYE CARE

Facility Address:
2848 NILES ROAD
SAINT JOSEPH, MI
ZIP 49085
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Facility Phone Number: 269 428-3300

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1003273129

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D1090689
LAB Type	Physician Office
Facility Name	GREAT LAKES EYE CARE
Street	2848 NILES ROAD
City	SAINT JOSEPH
State	MI
ZIP	49085
Phone	269 428-3300
CertificateType	4
CertificateEffectiveDate	10/16/2022
CertificateExpirationDate	10/15/2024
FacilityType	Waiver

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