39D1069953 CLIA NUMBER - RETINOVITREOUS ASSOCIATES LTD DBA MID ATLANTIC RETINA

Laboratory Demographics

  • CLIA Code: 39D1069953
  • Facility Name: RETINOVITREOUS ASSOCIATES LTD DBA MID ATLANTIC RETINA
  • Facility Address: 840 WALNUT ST SUITE 1015
    PHILADELPHIA, PA
    ZIP 19107
  • Facility Phone: 215 928-3092
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. CARL D. REGILLO MD
  • NPI Number: 1659326452
  • Taxonomy: 207W00000X - Ophthalmology

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CLIA Record

Field Name Field Value
CLIA Number 39D1069953
LAB Type Physician Office
Facility Name RETINOVITREOUS ASSOCIATES LTD DBA MID ATLANTIC RETINA
Street 840 WALNUT ST SUITE 1015
City PHILADELPHIA
State PA
ZIP 19107
Phone 215 928-3092
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/8/2024
Certificate Expiration Date 5/7/2026
Facility Type Physician Office
Lab Director DR. CARL D. REGILLO MD

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