45D2079649 CLIA NUMBER - WHITNEY FAMILY MEDICINE

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Laboratory Demographics

CLIA Number: 45D2079649

Facility Name: WHITNEY FAMILY MEDICINE

Facility Address:
1314 N BRAZOS STREET
WHITNEY, TX
ZIP 76692
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Facility Phone Number: 254 694-3621

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1508063504

Taxonomy: 332H00000X - Eyewear Supplier
An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.

CLIA Record

Field Name	Field Value
CLIA Number	45D2079649
LAB Type	Physician Office
Facility Name	WHITNEY FAMILY MEDICINE
Street	1314 N BRAZOS STREET
City	WHITNEY
State	TX
ZIP	76692
Phone	254 694-3621
CertificateType	3
CertificateEffectiveDate	6/19/2022
CertificateExpirationDate	6/18/2024
FacilityType	PPMP

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This page was last updated on: 4/23/2024