24D2076444 CLIA NUMBER - JOHN L BONNER EYE CLINIC LTD

Laboratory Demographics

  • CLIA Code: 24D2076444
  • Facility Name: JOHN L BONNER EYE CLINIC LTD
  • Facility Address: 1542 GOLF COURSE ROAD SUITE 201
    GRAND RAPIDS, MN
    ZIP 55744
  • Facility Phone: 218 326-3433
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: M JERRY MARIANO
  • NPI Number: 1053351817
  • Taxonomy: 207W00000X - Ophthalmology

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CLIA Record

Field Name Field Value
CLIA Number 24D2076444
LAB Type Physician Office
Facility Name JOHN L BONNER EYE CLINIC LTD
Street 1542 GOLF COURSE ROAD SUITE 201
City GRAND RAPIDS
State MN
ZIP 55744
Phone 218 326-3433
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/18/2024
Certificate Expiration Date 4/17/2026
Facility Type Physician Office
Lab Director M JERRY MARIANO

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