25D2166202 CLIA NUMBER - TRI COUNTY EYE CLINIC

Laboratory Demographics

  • CLIA Code: 25D2166202
  • Facility Name: TRI COUNTY EYE CLINIC
  • Facility Address: 15122 DEDEAUX ROAD
    GULFPORT, MS
    ZIP 39503
  • Facility Phone: 228 832-1242
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. GREGORY E. BERTUCCI
  • NPI Number: 1538337902
  • Taxonomy: 152WC0802X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 25D2166202
LAB Type Physician Office
Facility Name TRI COUNTY EYE CLINIC
Street 15122 DEDEAUX ROAD
City GULFPORT
State MS
ZIP 39503
Phone 228 832-1242
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/14/2025
Certificate Expiration Date 5/13/2027
Facility Type Physician Office
Lab Director DR. GREGORY E. BERTUCCI

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