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General NPI Number Information
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NPI Number | 1104341536
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Entity Type | Organization
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Legal Business Name | BLOOM EYE CARE, PLLC
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Dates
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Enumeration Date | 08/07/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 250 W 65TH ST
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City | LOVELAND
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State | CO
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Zip | 80538-4668
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Country | US
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Telephone | 970-699-5959
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Fax | 970-669-2154
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Provider Business Mailing Address
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Address Line | 250 W 65TH ST
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City | LOVELAND
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State | CO
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Zip | 80538-4668
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Country | US
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Telephone | 970-699-5959
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Fax | 970-669-2154
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | LANCE ELDEN BLOOM
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Credential | OD
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Telephone | 970-699-5959
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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 | OPT.0003017
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License Number State | CO
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