36D2294412 CLIA NUMBER - MONTGOMERY FAMILY MEDICINE B

Laboratory Demographics

  • CLIA Code: 36D2294412
  • Facility Name: MONTGOMERY FAMILY MEDICINE B
  • Facility Address: 11005 MONTGOMERY RD
    CINCINNATI, OH
    ZIP 45249
  • Facility Phone: 513 891-2211
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RICHARD VONDER BRINK
  • NPI Number: 1770770745
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 36D2294412
LAB Type Physician Office
Facility Name MONTGOMERY FAMILY MEDICINE B
Street 11005 MONTGOMERY RD
City CINCINNATI
State OH
ZIP 45249
Phone 513 891-2211
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/27/2023
Certificate Expiration Date 11/26/2025
Facility Type Physician Office
Lab Director RICHARD VONDER BRINK

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