25D1098836 CLIA NUMBER - DESOTO EYE SURGERY CENTER LLC

Laboratory Demographics

  • CLIA Code: 25D1098836
  • Facility Name: DESOTO EYE SURGERY CENTER LLC
  • Facility Address: 726 GOODMAN ROAD EAST SUITE B
    SOUTHAVEN, MS
    ZIP 38671
  • Facility Phone: 662 349-1959
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: ALAN R. SCHAEFFER
  • NPI Number: 1376576884
  • Taxonomy: 302F00000X - Exclusive Provider Organization

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CLIA Record

Field Name Field Value
CLIA Number 25D1098836
LAB Type Ambulatory Surgery Center
Facility Name DESOTO EYE SURGERY CENTER LLC
Street 726 GOODMAN ROAD EAST SUITE B
City SOUTHAVEN
State MS
ZIP 38671
Phone 662 349-1959
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/29/2025
Certificate Expiration Date 4/28/2027
Facility Type Ambulatory Surgery Center
Lab Director ALAN R. SCHAEFFER

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