37D1094387 CLIA NUMBER - IVANKA A VASSILEVA, MD

Laboratory Demographics

  • CLIA Code: 37D1094387
  • Facility Name: IVANKA A VASSILEVA, MD
  • Facility Address: 4411 W GORE BLVD, SUITE B-10
    LAWTON, OK
    ZIP 73505
  • Facility Phone: 580 354-9600
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: IVANKA A. VASSILEVA, MD
  • NPI Number: 1295729929
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 37D1094387
LAB Type Physician Office
Facility Name IVANKA A VASSILEVA, MD
Street 4411 W GORE BLVD, SUITE B-10
City LAWTON
State OK
ZIP 73505
Phone 580 354-9600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/16/2025
Certificate Expiration Date 1/15/2027
Facility Type Physician Office
Lab Director IVANKA A. VASSILEVA, MD

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