42D0721794 CLIA NUMBER - EASTSIDE MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 42D0721794
  • Facility Name: EASTSIDE MEDICAL GROUP
  • Facility Address: 4501 OLD SPARTANBURG ROAD, #14
    TAYLORS, SC
    ZIP 29687
  • Facility Phone: 864 268-1119
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOHN B. EBERLY MD
  • NPI Number: 1508164203
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 42D0721794
LAB Type Physician Office
Facility Name EASTSIDE MEDICAL GROUP
Street 4501 OLD SPARTANBURG ROAD, #14
City TAYLORS
State SC
ZIP 29687
Phone 864 268-1119
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director JOHN B. EBERLY MD

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