36D2079959 CLIA NUMBER - PROMEDICA PHYSICIANS DEFIANCE REGIONAL OPHTHALMOLOGY

Laboratory Demographics

  • CLIA Code: 36D2079959
  • Facility Name: PROMEDICA PHYSICIANS DEFIANCE REGIONAL OPHTHALMOLOGY
  • Facility Address: 1252 RALSTON AVE, SUITE #400
    DEFIANCE, OH
    ZIP 43512
  • Facility Phone: 419 787-3622
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JEFFERY N. STEPHENS
  • NPI Number: 1548397938
  • Taxonomy: 207X00000X - Orthopaedic Surgery

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CLIA Record

Field Name Field Value
CLIA Number 36D2079959
LAB Type Physician Office
Facility Name PROMEDICA PHYSICIANS DEFIANCE REGIONAL OPHTHALMOLOGY
Street 1252 RALSTON AVE, SUITE #400
City DEFIANCE
State OH
ZIP 43512
Phone 419 787-3622
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/27/2024
Certificate Expiration Date 6/26/2026
Facility Type Physician Office
Lab Director JEFFERY N. STEPHENS

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