36D2310108 CLIA NUMBER - GRAND LAKE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 36D2310108
  • Facility Name: GRAND LAKE PEDIATRICS
  • Facility Address: 801 PRO DR, STE D5
    CELINA, OH
    ZIP 45822
  • Facility Phone: 419 394-9579
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. ALEXANDER C. MAST
  • NPI Number: 1548301690
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 36D2310108
LAB Type Physician Office
Facility Name GRAND LAKE PEDIATRICS
Street 801 PRO DR, STE D5
City CELINA
State OH
ZIP 45822
Phone 419 394-9579
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/27/2024
Certificate Expiration Date 8/26/2026
Facility Type Physician Office
Lab Director DR. ALEXANDER C. MAST

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