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General NPI Number Information
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NPI Number | 1639321821
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Entity Type | Organization
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Legal Business Name | DR. BLOOMBERG'S EYE CLINIC
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 07/03/2019
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Provider Practice Location Address
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Address Line | 2200 NILES CORTLAND RD SE
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City | WARREN
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State | OH
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Zip | 44484-3042
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Country | US
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Telephone | 330-372-6676
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Fax | 330-372-9206
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Provider Business Mailing Address
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Address Line | 2200 NILES CORTLAND RD SE
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City | WARREN
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State | OH
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Zip | 44484-3042
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Country | US
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Telephone | 330-372-6676
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Fax | 330-372-9206
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MARLENE VEGA
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Credential |
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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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