Provider Demographics
NPI:1629066774
Name:JAMES W BLOOMER
Entity Type:Organization
Organization Name:JAMES W BLOOMER
Other - Org Name:BYERS OPTICAL SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:CERTIFIED OPTICIAN / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:BLOOMAR
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:785-272-9155
Mailing Address - Street 1:5331 SW 22ND PL
Mailing Address - Street 2:SUITE 70
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-1518
Mailing Address - Country:US
Mailing Address - Phone:785-272-9155
Mailing Address - Fax:785-272-9155
Practice Address - Street 1:5331 SW 22ND PL
Practice Address - Street 2:SUITE 70
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-1518
Practice Address - Country:US
Practice Address - Phone:785-272-9155
Practice Address - Fax:785-272-9155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100334820AMedicaid
KS7609Medicare UPIN
KS100334820AMedicaid