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General NPI Number Information
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NPI Number | 1255339065
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Entity Type | Organization
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Legal Business Name | BLOOM VISION, LLC
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Dates
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Enumeration Date | 07/14/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 301 EAST ST
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City | BLOOMSBURG
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State | PA
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Zip | 17815-1846
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Country | US
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Telephone | 570-387-8800
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Fax | 570-784-8887
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Provider Business Mailing Address
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Address Line | 301 EAST ST
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City | BLOOMSBURG
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State | PA
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Zip | 17815-1846
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Country | US
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Telephone | 570-387-8800
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Fax | 570-784-8887
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Authorized Official
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Title or Position | BILLING CLERK
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Name | TRACY SAVIDGE
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Credential |
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Telephone | 570-387-8800
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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 | PA
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