24D1066680 CLIA NUMBER - VITREORETINAL SURGERY

Laboratory Demographics

  • CLIA Code: 24D1066680
  • Facility Name: VITREORETINAL SURGERY
  • Facility Address: CENTENNIAL LAKES PARK III 3601 76TH STREET WEST SUITE 300
    EDINA, MN
    ZIP 55435
  • Facility Phone: 952 929-1131
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROBERT MITTRA
  • NPI Number: 1891783965
  • Taxonomy: 207W00000X - Ophthalmology

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CLIA Record

Field Name Field Value
CLIA Number 24D1066680
LAB Type Physician Office
Facility Name VITREORETINAL SURGERY
Street CENTENNIAL LAKES PARK III 3601 76TH STREET WEST SUITE 300
City EDINA
State MN
ZIP 55435
Phone 952 929-1131
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/29/2025
Certificate Expiration Date 3/28/2027
Facility Type Physician Office
Lab Director ROBERT MITTRA

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