05D0698619 CLIA NUMBER - BRUCE BLACKHART MD

Laboratory Demographics

  • CLIA Code: 05D0698619
  • Facility Name: BRUCE BLACKHART MD
  • Facility Address: 1425 WEST H ST, SUITE 200
    OAKDALE, CA
    ZIP 95361
  • Facility Phone: 209 848-1005
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: LEE J. HORWITZ
  • NPI Number: 1700874286
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0698619
LAB Type Physician Office
Facility Name BRUCE BLACKHART MD
Street 1425 WEST H ST, SUITE 200
City OAKDALE
State CA
ZIP 95361
Phone 209 848-1005
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 11/2/2024
Certificate Expiration Date 11/1/2026
Facility Type Physician Office
Lab Director LEE J. HORWITZ

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