NPIMap

Organization Active NPI

Bloom Vision, LLC

  • Optometrist
  • Bloomsburg, PA
National Provider Identifier
1255339065
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
BLOOM VISION, LLC
Practice address
301 East St
Bloomsburg, PA 17815-1846
Phone
(570) 387-8800
Fax
(570) 784-8887
NPI assigned
Jul 14, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tracy Savidge
Title
Billing Clerk
Phone
(570) 387-8800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X PA Primary

Addresses

Primary practice location

301 East St
Bloomsburg, PA 17815-1846

Mailing address

301 East St
Bloomsburg, PA 17815-1846
Phone (570) 387-8800

Other identifiers 4

IdentifierTypeStateIssuer
436035OtherPAKEYSTONE HEALTH PLAN CENT
436035OtherPABLUE SHIELD
436035OtherPAFIRST PRIORITY HEALTH
02497000OtherPACAPITAL BLUE CROSS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1255339065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 EAST ST",
            "city": "BLOOMSBURG",
            "state": "PA",
            "postal_code": "178151846",
            "telephone_number": "570-387-8800",
            "fax_number": "570-784-8887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 EAST ST",
            "city": "BLOOMSBURG",
            "state": "PA",
            "postal_code": "178151846",
            "telephone_number": "570-387-8800",
            "fax_number": "570-784-8887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM VISION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-14",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "SAVIDGE",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "BILLING CLERK",
        "authorized_official_telephone_number": "570-387-8800"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE HEALTH PLAN CENT",
            "identifier": "436035",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "436035",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PRIORITY HEALTH",
            "identifier": "436035",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "02497000",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomsburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.