44D2095252 CLIA NUMBER - SOUTHEASTERN RETINA ASSOCIATES

Laboratory Demographics

  • CLIA Code: 44D2095252
  • Facility Name: SOUTHEASTERN RETINA ASSOCIATES
  • Facility Address: 1961 NORTHPOINT BLVD, STE 110
    HIXSON, TN
    ZIP 37343
  • Facility Phone: 423 756-1002
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RICHARD BREAZEALE
  • NPI Number: 1518961176
  • Taxonomy: 207W00000X - Ophthalmology

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CLIA Record

Field Name Field Value
CLIA Number 44D2095252
LAB Type Physician Office
Facility Name SOUTHEASTERN RETINA ASSOCIATES
Street 1961 NORTHPOINT BLVD, STE 110
City HIXSON
State TN
ZIP 37343
Phone 423 756-1002
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/4/2025
Certificate Expiration Date 5/3/2027
Facility Type Physician Office
Lab Director RICHARD BREAZEALE

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