39D1023713 CLIA NUMBER - LIBERTY EYE SURGICAL CENTER LLC

Laboratory Demographics

CLIA Number: 39D1023713

Facility Name: LIBERTY EYE SURGICAL CENTER LLC

Facility Address:
9122 BLUE GRASS ROAD
PHILADELPHIA, PA
ZIP 19114
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Facility Phone Number: 215 673-9231

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1447218433

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	39D1023713
LAB Type	Ambulatory Surgery Center
Facility Name	LIBERTY EYE SURGICAL CENTER LLC
Street	9122 BLUE GRASS ROAD
City	PHILADELPHIA
State	PA
ZIP	19114
Phone	215 673-9231
CertificateType	4
CertificateEffectiveDate	3/24/2024
CertificateExpirationDate	3/23/2026
FacilityType	Waiver

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