Healthcare Provider Details

I. General information

NPI: 1649342890
Provider Name (Legal Business Name): BLOOM FAMILY EYE SURGEONS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLZ
DAYTON OH
45404-1898
US

IV. Provider business mailing address

1 CHILDRENS PLZ
DAYTON OH
45404-1898
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3020
  • Fax: 937-226-9605
Mailing address:
  • Phone: 937-723-7772
  • Fax: 937-226-9605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT T BLOOM
Title or Position: OWNER
Credential: M.D.
Phone: 937-723-7772