45D2283734 CLIA NUMBER - ENVISION IMAGING OLD TOWN

Laboratory Demographics

  • CLIA Code: 45D2283734
  • Facility Name: ENVISION IMAGING OLD TOWN
  • Facility Address: 5500 GREENVILLE AVE SUITE 1100
    DALLAS, TX
    ZIP 75206
  • Facility Phone: (469) 648-3700
  • Facility Type: Other - OUTPATIENT DIAG IMAGING
  • Facility Type: Waiver
  • Lab Director: WES WINDHAM
  • NPI Number: 1982317079
  • Taxonomy: 293D00000X - Physiological Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 45D2283734
LAB Type Other - OUTPATIENT DIAG IMAGING
Facility Name ENVISION IMAGING OLD TOWN
Street 5500 GREENVILLE AVE SUITE 1100
City DALLAS
State TX
ZIP 75206
Phone 4696483700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/13/2025
Certificate Expiration Date 6/12/2027
Facility Type Other - OUTPATIENT DIAG IMAGING
Lab Director WES WINDHAM

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This page was last updated on: 5/18/2026