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General NPI Number Information
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NPI Number | 1154491629
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Entity Type | Organization
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Legal Business Name | BLOOM EYE ASSOCIATES, LTD.
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 525 JAMESTOWN ST SUITE 207
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City | PHILADELPHIA
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State | PA
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Zip | 19128-1751
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Country | US
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Telephone | 215-483-8444
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Fax | 215-482-8456
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Provider Business Mailing Address
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Address Line | 525 JAMESTOWN ST SUITE 207
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City | PHILADELPHIA
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State | PA
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Zip | 19128-1751
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Country | US
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Telephone | 215-483-8444
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Fax | 215-482-8456
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAWRENCE HOWARD BLOOM
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Credential | M.D.
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Telephone | 215-483-8444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD020108
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License Number State | PA
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