Scott Bloom OD PLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901003603 Issued in MI

Legal business name

SCOTT BLOOM OD PLC

Practice address

1510 N Broadway St
Hastings, MI 49058-1007

Phone

(269) 945-2192

NPI assigned

Oct 17, 2007

Organization subpart

No

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

Authorized official

Name

Scott Bloom, O.D.NPI 1407904188

Title

Owner

Phone

(269) 945-2192

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

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

• Scott Bloom

  • Optometrist
  • Hastings, MI
  • NPI 1407904188
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1192579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236643200000",
    "number": "1376732131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 N BROADWAY ST",
            "city": "HASTINGS",
            "state": "MI",
            "postal_code": "490581007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 N BROADWAY ST",
            "city": "HASTINGS",
            "state": "MI",
            "postal_code": "490581007",
            "telephone_number": "269-945-2192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTT BLOOM OD PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-17",
        "last_updated": "2009-03-10",
        "status": "A",
        "authorized_official_last_name": "BLOOM",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "269-945-2192",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901003603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tovah Leigh Sanford, MS, OTR
• Camilyn Sauve
• Kirsten Elizabeth Saverstrom, PHARMD
• Matthew T Scarff, MD
• Sara Scofield
• Scott Brasseur MD PLC
• Duane Secord, MA, LLP
• Jamie See, LMSW
• Melissa M Seeger, RN
• Jennifer Lee Seif, CPM, LM

• Optometrist in Hastings, MI
• Providers in Hastings, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.