34D2159224 CLIA NUMBER - PROVIDENCE EYE AND LASER SPECIALISTS

Laboratory Demographics

  • CLIA Code: 34D2159224
  • Facility Name: PROVIDENCE EYE AND LASER SPECIALISTS
  • Facility Address: 3025 SPRING BANK LANE, SUITE 200
    CHARLOTTE, NC
    ZIP 28226
  • Facility Phone: 704 540-9595
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: REZA M. MOZAYENI
  • NPI Number: 1154367217
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 34D2159224
LAB Type Physician Office
Facility Name PROVIDENCE EYE AND LASER SPECIALISTS
Street 3025 SPRING BANK LANE, SUITE 200
City CHARLOTTE
State NC
ZIP 28226
Phone 704 540-9595
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/14/2024
Certificate Expiration Date 12/13/2026
Facility Type Physician Office
Lab Director REZA M. MOZAYENI

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