45D1057143 CLIA NUMBER - BURLESON OLD TOWN MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 45D1057143
  • Facility Name: BURLESON OLD TOWN MEDICAL CENTER
  • Facility Address: 309 NW RENFRO ST SUITE 201
    BURLESON, TX
    ZIP 76028
  • Facility Phone: 817 295-3100
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOE M. ETTER
  • NPI Number: 1164846259
  • Taxonomy: 152W00000X - Optometrist

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 45D1057143
LAB Type Physician Office
Facility Name BURLESON OLD TOWN MEDICAL CENTER
Street 309 NW RENFRO ST SUITE 201
City BURLESON
State TX
ZIP 76028
Phone 817 295-3100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/17/2025
Certificate Expiration Date 4/16/2027
Facility Type Physician Office
Lab Director JOE M. ETTER

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 3/20/2025