25D2054053 CLIA NUMBER - 20/20 EYE CARE OF GRENADA PA

Laboratory Demographics

  • CLIA Code: 25D2054053
  • Facility Name: 20/20 EYE CARE OF GRENADA PA
  • Facility Address: 600 OLD HICKORY ROAD
    GRENADA, MS
    ZIP 38901
  • Facility Phone: 662 226-7010
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHRISTOPHER T. WALLS
  • NPI Number: 1528242047
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 25D2054053
LAB Type Physician Office
Facility Name 20/20 EYE CARE OF GRENADA PA
Street 600 OLD HICKORY ROAD
City GRENADA
State MS
ZIP 38901
Phone 662 226-7010
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/13/2025
Certificate Expiration Date 2/12/2027
Facility Type Physician Office
Lab Director CHRISTOPHER T. WALLS

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