23D2080419 CLIA NUMBER - FOUNTAIN OPTOMETRY, P C

Laboratory Demographics

  • CLIA Code: 23D2080419
  • Facility Name: FOUNTAIN OPTOMETRY, P C
  • Facility Address: 7 E MAIN STREET
    MILAN, MI
    ZIP 48160
  • Facility Phone: 734 439-2020
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KEVIN M. FOUNTAIN
  • NPI Number: 1003991183
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 23D2080419
LAB Type Physician Office
Facility Name FOUNTAIN OPTOMETRY, P C
Street 7 E MAIN STREET
City MILAN
State MI
ZIP 48160
Phone 734 439-2020
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/8/2024
Certificate Expiration Date 7/7/2026
Facility Type Physician Office
Lab Director KEVIN M. FOUNTAIN

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This page was last updated on: 6/4/2025