Provider Demographics
NPI:1346205481
Name:BLOOMINGTON EYE INSTITUTE LLC
Entity Type:Organization
Organization Name:BLOOMINGTON EYE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARA
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:APRAHAMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-829-5311
Mailing Address - Street 1:1008 NORTH CENTER ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-2778
Mailing Address - Country:US
Mailing Address - Phone:309-827-2020
Mailing Address - Fax:309-828-4586
Practice Address - Street 1:1008 NORTH CENTER ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-2778
Practice Address - Country:US
Practice Address - Phone:309-827-2020
Practice Address - Fax:309-828-4586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7002249261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1547OtherBLUE CROSS BLUE SHIELD
IL039339OtherHEALTH ALLIANCE
490003926OtherPALMETTO RAILROAD MEDICAR
490003926OtherPALMETTO RAILROAD MEDICAR
IL039339OtherHEALTH ALLIANCE