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General NPI Number Information
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NPI Number | 1174850846
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Entity Type | Organization
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Legal Business Name | BLOOM FAMILY EYE SURGEONS
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Dates
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Enumeration Date | 11/17/2009
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Last Update Date | 11/17/2009
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Provider Practice Location Address
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Address Line | 2302 CHESTER BLVD
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City | RICHMOND
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State | IN
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Zip | 47374-1221
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Country | US
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Telephone | 937-641-3020
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Fax | 937-226-9605
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Provider Business Mailing Address
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Address Line | 1 CHILDRENS PLZ
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City | DAYTON
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State | OH
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Zip | 45404-1898
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Country | US
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Telephone | 937-641-3020
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Fax | 937-226-9605
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Authorized Official
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Title or Position | MD
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Name | DR. MICHAEL BLOOM
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Credential |
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Telephone | 937-641-3020
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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 | 01051532A
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License Number State | IN
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