Provider Demographics
NPI:1104341536
Name:BLOOM EYE CARE, PLLC
Entity type:Organization
Organization Name:BLOOM EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:ELDEN
Authorized Official - Last Name:BLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-699-5959
Mailing Address - Street 1:250 W 65TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4668
Mailing Address - Country:US
Mailing Address - Phone:970-699-5959
Mailing Address - Fax:970-669-2154
Practice Address - Street 1:250 W 65TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4668
Practice Address - Country:US
Practice Address - Phone:970-699-5959
Practice Address - Fax:970-669-2154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003017152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty