25D2068707 CLIA NUMBER - O'BRIEN VISION CENTER

Laboratory Demographics

  • CLIA Code: 25D2068707
  • Facility Name: O'BRIEN VISION CENTER
  • Facility Address: 1890 GOODMAN ROAD E, SUITE 100
    SOUTHAVEN, MS
    ZIP 38671
  • Facility Phone: 662 772-5882
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JONATHAN W. WILSON
  • NPI Number: 1518046234
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 25D2068707
LAB Type Physician Office
Facility Name O'BRIEN VISION CENTER
Street 1890 GOODMAN ROAD E, SUITE 100
City SOUTHAVEN
State MS
ZIP 38671
Phone 662 772-5882
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/12/2023
Certificate Expiration Date 11/11/2025
Facility Type Physician Office
Lab Director JONATHAN W. WILSON

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