33D0719039 CLIA NUMBER - OPTUM MEDICAL CARE PC

Laboratory Demographics

  • CLIA Code: 33D0719039
  • Facility Name: OPTUM MEDICAL CARE PC
  • Facility Address: 860 ATLANTIC AVENUE
    BALDWIN HARBOR, NY
    ZIP 11510
  • Facility Phone: 516 868-6100
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: DR. VICKI E. JETTER
  • NPI Number: 1497776421
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 33D0719039
LAB Type Physician Office
Facility Name OPTUM MEDICAL CARE PC
Street 860 ATLANTIC AVENUE
City BALDWIN HARBOR
State NY
ZIP 11510
Phone 516 868-6100
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 9/9/2024
Certificate Expiration Date 9/8/2026
Facility Type Physician Office
Lab Director DR. VICKI E. JETTER

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