Provider Demographics
NPI:1043108897
Name:BLOOMINGTON OPTOMETRY LLC
Entity type:Organization
Organization Name:BLOOMINGTON OPTOMETRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICCAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-219-7039
Mailing Address - Street 1:2022 E LUKES CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-9485
Mailing Address - Country:US
Mailing Address - Phone:812-219-7039
Mailing Address - Fax:
Practice Address - Street 1:26 N BROWN AVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-1523
Practice Address - Country:US
Practice Address - Phone:812-872-2020
Practice Address - Fax:812-814-4106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty