50D2100179 CLIA NUMBER - VISION SOURCE WALLA WALLA

Laboratory Demographics

  • CLIA Code: 50D2100179
  • Facility Name: VISION SOURCE WALLA WALLA
  • Facility Address: 614 E ALDER ST STE 1
    WALLA WALLA, WA
    ZIP 99362
  • Facility Phone: 509 529-9660
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DANIEL J. WIESSNER
  • NPI Number: 1851537021
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 50D2100179
LAB Type Physician Office
Facility Name VISION SOURCE WALLA WALLA
Street 614 E ALDER ST STE 1
City WALLA WALLA
State WA
ZIP 99362
Phone 509 529-9660
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/10/2015
Certificate Expiration Date 4/4/2028
Facility Type Physician Office
Lab Director DANIEL J. WIESSNER

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