Provider Demographics
NPI:1336129923
Name:BLOOM, ERROL M (OD)
Entity Type:Individual
Prefix:
First Name:ERROL
Middle Name:M
Last Name:BLOOM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 WESTBANK EXPY
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-3654
Mailing Address - Country:US
Mailing Address - Phone:504-366-9435
Mailing Address - Fax:504-368-5585
Practice Address - Street 1:80 WESTBANK EXPY
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-3654
Practice Address - Country:US
Practice Address - Phone:504-366-9435
Practice Address - Fax:504-368-5585
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA856-214T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1350311Medicaid
LA1350311Medicaid
LA48980Medicare ID - Type Unspecified