Healthcare Provider Details

I. General information

NPI: 1811124282
Provider Name (Legal Business Name): JUSTIN D BLOOMBERG DO, OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2009
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 ERIE CT SUITE L700
OAK PARK IL
60302-2519
US

IV. Provider business mailing address

3 ERIE CT SUITE L700
OAK PARK IL
60302-2519
US

V. Phone/Fax

Practice location:
  • Phone: 708-763-1222
  • Fax: 708-763-1471
Mailing address:
  • Phone: 708-763-1222
  • Fax: 708-763-1471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberDO-05540
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: