36D0954041 CLIA NUMBER - PROSPECT FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 36D0954041
  • Facility Name: PROSPECT FAMILY MEDICINE
  • Facility Address: 102 E WATER STREET
    PROSPECT, OH
    ZIP 43342
  • Facility Phone: 740 494-2624
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MARK J. PIACENTINI
  • NPI Number: 1881852804
  • Taxonomy: 152W00000X - Optometrist

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 36D0954041
LAB Type Physician Office
Facility Name PROSPECT FAMILY MEDICINE
Street 102 E WATER STREET
City PROSPECT
State OH
ZIP 43342
Phone 740 494-2624
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 5/25/2024
Certificate Expiration Date 5/24/2026
Facility Type Physician Office
Lab Director MARK J. PIACENTINI

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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