39D1010108 CLIA NUMBER - PA EYE & EAR SURGERY CENTER LLC

Laboratory Demographics

CLIA Number: 39D1010108

Facility Name: PA EYE & EAR SURGERY CENTER LLC

Facility Address:
1 GRANITE POINT DRIVE SUITE 200
WYOMISSING, PA
ZIP 19610
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Facility Phone Number: 610 685-9204

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1609848472

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	39D1010108
LAB Type	Ambulatory Surgery Center
Facility Name	PA EYE & EAR SURGERY CENTER LLC
Street	1 GRANITE POINT DRIVE SUITE 200
City	WYOMISSING
State	PA
ZIP	19610
Phone	610 685-9204
CertificateType	4
CertificateEffectiveDate	3/6/2023
CertificateExpirationDate	3/5/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024