Healthcare Provider Details

I. General information

NPI: 1821076282
Provider Name (Legal Business Name): BLOOM OPTICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 N CLARKSON ST
FREMONT NE
68025-2371
US

IV. Provider business mailing address

2921 N CLARKSON ST
FREMONT NE
68025-2371
US

V. Phone/Fax

Practice location:
  • Phone: 402-721-8823
  • Fax: 402-721-2482
Mailing address:
  • Phone: 402-721-8823
  • Fax: 402-721-2482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1085
License Number StateNE

VIII. Authorized Official

Name: DR. STEVE D ALCORN
Title or Position: SECRETARY/TREASURER
Credential: O.D.
Phone: 402-721-8823