MEDICARE: ERROL M. BLOOM O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	856-214T	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336129923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERROL M. BLOOM O.D.

Provider Business Mailing Address
First Line	:	80 WESTBANK EXPY
Second Line	:
City	:	GRETNA
State	:	LA
Zip	:	70053-3654
Country	:	US
Telephone Number	:	504-366-9435
Fax Number	:	504-368-5585

Provider Business Practice Location Address
First Line	:	80 WESTBANK EXPY
Second Line	:
City	:	GRETNA
State	:	LA
Zip	:	70053-3654
Country	:	US
Telephone Number	:	504-366-9435
Fax Number	:	504-368-5585

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	07/08/2007

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