23D2039582 CLIA NUMBER - RIVERSIDE EYE CENTER

Laboratory Demographics

  • CLIA Code: 23D2039582
  • Facility Name: RIVERSIDE EYE CENTER
  • Facility Address: 4656 24TH AVE
    FORT GRATIOT, MI
    ZIP 48059
  • Facility Phone: 810 385-3600
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EDWARD M. BALOK
  • NPI Number: 1174748081
  • Taxonomy: 207W00000X - Ophthalmology

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CLIA Record

Field Name Field Value
CLIA Number 23D2039582
LAB Type Physician Office
Facility Name RIVERSIDE EYE CENTER
Street 4656 24TH AVE
City FORT GRATIOT
State MI
ZIP 48059
Phone 810 385-3600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/12/2024
Certificate Expiration Date 4/11/2026
Facility Type Physician Office
Lab Director EDWARD M. BALOK

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