Provider Demographics
NPI:1770165987
Name:BLOOM OPTOMETRY CLINIC, P.C.
Entity type:Organization
Organization Name:BLOOM OPTOMETRY CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HEITMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:504-366-9435
Mailing Address - Street 1:91 WESTBANK EXPY STE 510
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-3693
Mailing Address - Country:US
Mailing Address - Phone:504-366-9435
Mailing Address - Fax:504-368-5585
Practice Address - Street 1:91 WESTBANK EXPY STE 510
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-3693
Practice Address - Country:US
Practice Address - Phone:504-366-9435
Practice Address - Fax:504-368-5585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1350311Medicaid
LA2539329Medicaid
LA2539329Medicaid
LAMB1876361OtherDEA