34D2080636 CLIA NUMBER - RETINA OF COASTAL CAROLINA, PLLC

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Laboratory Demographics

CLIA Number: 34D2080636

Facility Name: RETINA OF COASTAL CAROLINA, PLLC

Facility Address:
1899 N MARINE BOULEVARD, SUITE 400
JACKSONVILLE, NC
ZIP 28546
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Facility Phone Number: 910 254-2023

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1326089442

Taxonomy: 207WX0107X - Ophthalmology
An ophthalmologist who specializes in the diagnosis and treatment of vitreoretinal diseases.

CLIA Record

Field Name	Field Value
CLIA Number	34D2080636
LAB Type	Physician Office
Facility Name	RETINA OF COASTAL CAROLINA, PLLC
Street	1899 N MARINE BOULEVARD, SUITE 400
City	JACKSONVILLE
State	NC
ZIP	28546
Phone	910 254-2023
CertificateType	4
CertificateEffectiveDate	7/11/2022
CertificateExpirationDate	7/10/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024