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General NPI Number Information
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NPI Number | 1043108897
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Entity Type | Organization
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Legal Business Name | BLOOMINGTON OPTOMETRY LLC
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Dates
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Enumeration Date | 06/27/2025
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 26 N BROWN AVE
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City | TERRE HAUTE
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State | IN
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Zip | 47803-1523
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Country | US
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Telephone | 812-872-2020
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Fax | 812-814-4106
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Provider Business Mailing Address
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Address Line | 2022 E LUKES CT
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City | BLOOMINGTON
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State | IN
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Zip | 47401-9485
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Country | US
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Telephone | 812-219-7039
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICCAH A HOFFMAN
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Credential | OD
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Telephone | 812-219-7039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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