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General NPI Number Information
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NPI Number | 1326290594
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Entity Type | Organization
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Legal Business Name | DR BLOOMBERG EYE CLINIC
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Dates
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Enumeration Date | 10/19/2008
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 1449 BOARDMAN CANFIELD RD STE 230
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City | BOARDMAN
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State | OH
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Zip | 44512-8053
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Country | US
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Telephone | 330-758-6671
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Fax | 330-758-1451
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Provider Business Mailing Address
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Address Line | 1449 BOARDMAN CANFIELD RD STE 230
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City | BOARDMAN
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State | OH
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Zip | 44512-8053
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Country | US
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Telephone | 330-758-6671
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Fax | 330-758-1451
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRAD E. BLOOMBERG
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Credential | OD
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Telephone | 330-758-6671
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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 | 4008/T-032
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License Number State | OH
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