24D2135066 CLIA NUMBER - RIVER LAKE CLINIC LLC

Laboratory Demographics

  • CLIA Code: 24D2135066
  • Facility Name: RIVER LAKE CLINIC LLC
  • Facility Address: 4323 EAST LAKE STEET
    MINNEAPOLIS, MN
    ZIP 55406
  • Facility Phone: 612 721-6336
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOSHUA HANEN
  • NPI Number: 1902932965
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 24D2135066
LAB Type Physician Office
Facility Name RIVER LAKE CLINIC LLC
Street 4323 EAST LAKE STEET
City MINNEAPOLIS
State MN
ZIP 55406
Phone 612 721-6336
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/15/2025
Certificate Expiration Date 8/14/2027
Facility Type Physician Office
Lab Director JOSHUA HANEN

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