24D2122617 CLIA NUMBER - NORTHWEST EYE CLINIC, LLC

Laboratory Demographics

  • CLIA Code: 24D2122617
  • Facility Name: NORTHWEST EYE CLINIC, LLC
  • Facility Address: 250 CENTRAL AVE NORTH STE 107 & 105
    WAYZATA, MN
    ZIP 55391
  • Facility Phone: 763 416-7600
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DENISE TOMNICZAK
  • NPI Number: 1164508917
  • Taxonomy: 207W00000X - Ophthalmology

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CLIA Record

Field Name Field Value
CLIA Number 24D2122617
LAB Type Physician Office
Facility Name NORTHWEST EYE CLINIC, LLC
Street 250 CENTRAL AVE NORTH STE 107 & 105
City WAYZATA
State MN
ZIP 55391
Phone 763 416-7600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/1/2024
Certificate Expiration Date 11/30/2026
Facility Type Physician Office
Lab Director DENISE TOMNICZAK

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