Provider Demographics
NPI:1295784916
Name:BLOM, ERIC E (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:E
Last Name:BLOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3155 N UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-8703
Mailing Address - Country:US
Mailing Address - Phone:719-630-3937
Mailing Address - Fax:719-635-3578
Practice Address - Street 1:3155 N UNION BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8703
Practice Address - Country:US
Practice Address - Phone:719-630-3937
Practice Address - Fax:719-635-3578
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO43724207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO75727749Medicaid
COBL672952OtherANTHEM
COCO3724OtherEYEMED EYECARE
COP00243931OtherRAILROAD MEDICARE
CO608436900OtherUS DEPT LABOR WORK COMP
CO923384020820OtherEYE SPECIALISTS
CO0452890001OtherMEDICARE DMERC
COP00243931OtherRAILROAD MEDICARE
CO608436900OtherUS DEPT LABOR WORK COMP