46D1083153 CLIA NUMBER - ROOSEVELT CBOC

Laboratory Demographics

  • CLIA Code: 46D1083153
  • Facility Name: ROOSEVELT CBOC
  • Facility Address: 245 WEST 200 NORTH
    ROOSEVELT, UT
    ZIP 84066
  • Facility Phone: 435 725-1050
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: GARY F. GRAHAM
  • NPI Number: 1710973052
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 46D1083153
LAB Type Community Clinic
Facility Name ROOSEVELT CBOC
Street 245 WEST 200 NORTH
City ROOSEVELT
State UT
ZIP 84066
Phone 435 725-1050
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/28/2024
Certificate Expiration Date 4/27/2026
Facility Type Community Clinic
Lab Director GARY F. GRAHAM

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