Healthcare Provider Details

I. General information

NPI: 1255339065
Provider Name (Legal Business Name): BLOOM VISION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 EAST ST
BLOOMSBURG PA
17815-1846
US

IV. Provider business mailing address

301 EAST ST
BLOOMSBURG PA
17815-1846
US

V. Phone/Fax

Practice location:
  • Phone: 570-387-8800
  • Fax: 570-784-8887
Mailing address:
  • Phone: 570-387-8800
  • Fax: 570-784-8887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StatePA

VIII. Authorized Official

Name: TRACY SAVIDGE
Title or Position: BILLING CLERK
Credential:
Phone: 570-387-8800