23D2021884 CLIA NUMBER - GRAND RAPIDS OPHTHALMOLOGY

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Laboratory Demographics

CLIA Number: 23D2021884

Facility Name: GRAND RAPIDS OPHTHALMOLOGY

Facility Address:
750 E BELTLINE AVENUE NE
GRAND RAPIDS, MI
ZIP 49525
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Facility Phone Number: 616 949-2600

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1265591390

Taxonomy: 332H00000X - Eyewear Supplier
An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.

CLIA Record

Field Name	Field Value
CLIA Number	23D2021884
LAB Type	Practitioner Other
Facility Name	GRAND RAPIDS OPHTHALMOLOGY
Street	750 E BELTLINE AVENUE NE
City	GRAND RAPIDS
State	MI
ZIP	49525
Phone	616 949-2600
CertificateType	4
CertificateEffectiveDate	7/11/2023
CertificateExpirationDate	7/10/2025
FacilityType	Waiver

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