Provider Demographics
NPI:1255339065
Name:BLOOM VISION, LLC
Entity type:Organization
Organization Name:BLOOM VISION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-387-8800
Mailing Address - Street 1:301 EAST ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-1846
Mailing Address - Country:US
Mailing Address - Phone:570-387-8800
Mailing Address - Fax:570-784-8887
Practice Address - Street 1:301 EAST ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1846
Practice Address - Country:US
Practice Address - Phone:570-387-8800
Practice Address - Fax:570-784-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA436035OtherKEYSTONE HEALTH PLAN CENT
PA436035OtherBLUE SHIELD
PA436035OtherFIRST PRIORITY HEALTH
PA02497000OtherCAPITAL BLUE CROSS
PA436035OtherBLUE SHIELD
PA436035Medicare ID - Type Unspecified