43D2156567 CLIA NUMBER - VISION SOURCE SPECIALISTS PROF LLC

Laboratory Demographics

  • CLIA Code: 43D2156567
  • Facility Name: VISION SOURCE SPECIALISTS PROF LLC
  • Facility Address: 318 MT RUSHMORE RD SUITE A
    RAPID CITY, SD
    ZIP 57701
  • Facility Phone: (605) 399-3937
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAWN WATTENHOFER
  • NPI Number: 1568863496
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 43D2156567
LAB Type Physician Office
Facility Name VISION SOURCE SPECIALISTS PROF LLC
Street 318 MT RUSHMORE RD SUITE A
City RAPID CITY
State SD
ZIP 57701
Phone 6053993937
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/19/2024
Certificate Expiration Date 10/18/2026
Facility Type Physician Office
Lab Director DAWN WATTENHOFER

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This page was last updated on: 6/29/2026