Healthcare Provider Details

I. General information

NPI: 1346205481
Provider Name (Legal Business Name): BLOOMINGTON EYE INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 NORTH CENTER ST
BLOOMINGTON IL
61701-2778
US

IV. Provider business mailing address

1008 NORTH CENTER ST
BLOOMINGTON IL
61701-2778
US

V. Phone/Fax

Practice location:
  • Phone: 309-827-2020
  • Fax: 309-828-4586
Mailing address:
  • Phone: 309-827-2020
  • Fax: 309-828-4586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number7002249
License Number StateIL

VIII. Authorized Official

Name: DR. ARA DAVID APRAHAMIAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 309-829-5311