46D2307666 CLIA NUMBER - WASATCH OPTIMAL WELLNESS CLINIC, LLC

Laboratory Demographics

  • CLIA Code: 46D2307666
  • Facility Name: WASATCH OPTIMAL WELLNESS CLINIC, LLC
  • Facility Address: 1716 N HIGHWAY 40, SUITE 200
    HEBER CITY, UT
    ZIP 84032
  • Facility Phone: 435 800-6969
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: BENJAMIN FOGG
  • NPI Number: 1508619040
  • Taxonomy: 261QH0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 46D2307666
LAB Type Community Clinic
Facility Name WASATCH OPTIMAL WELLNESS CLINIC, LLC
Street 1716 N HIGHWAY 40, SUITE 200
City HEBER CITY
State UT
ZIP 84032
Phone 435 800-6969
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/12/2024
Certificate Expiration Date 7/11/2026
Facility Type Community Clinic
Lab Director BENJAMIN FOGG

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