25D1024744 CLIA NUMBER - EYE CARE SURGERY CENTER OF OLIVE BRANCH

Laboratory Demographics

CLIA Number: 25D1024744

Facility Name: EYE CARE SURGERY CENTER OF OLIVE BRANCH

Facility Address:
6947 CRUMPLER BLVD SUITE 105
OLIVE BRANCH, MS
ZIP 38654
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Facility Phone Number: 662 893-3306

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1720161771

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D1024744
LAB Type	Ambulatory Surgery Center
Facility Name	EYE CARE SURGERY CENTER OF OLIVE BRANCH
Street	6947 CRUMPLER BLVD SUITE 105
City	OLIVE BRANCH
State	MS
ZIP	38654
Phone	662 893-3306
CertificateType	4
CertificateEffectiveDate	4/21/2024
CertificateExpirationDate	4/20/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024