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General NPI Number Information
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NPI Number | 1952439234
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Entity Type | Organization
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Legal Business Name | BLOOMINGTON EYE CARE PC
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 10/16/2012
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Provider Practice Location Address
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Address Line | 2600 W 3RD ST
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City | BLOOMINGTON
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State | IN
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Zip | 47404-5227
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Country | US
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Telephone | 812-336-5432
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Fax | 812-332-5084
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Provider Business Mailing Address
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Address Line | 2600 W 3RD ST
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City | BLOOMINGTON
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State | IN
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Zip | 47404-5227
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Country | US
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Telephone | 812-336-5432
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Fax | 812-332-5084
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARGARET S MCCALLA-JACKSON
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Credential | OD
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Telephone | 812-336-5432
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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 | 56000371A
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License Number State | IN
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