NPIMap

Organization Active NPI

Bloom Optical, LLC

  • Optometrist
  • Fremont, NE
National Provider Identifier
1821076282
Registry record updated Nov 15, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1085 Issued in NE
Legal business name
BLOOM OPTICAL, LLC
Practice address
2921 N Clarkson St
Fremont, NE 68025-2371
Phone
(402) 721-8823
Fax
(402) 721-2482
NPI assigned
Jan 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2007

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

Authorized official

Name
Dr. Steve D Alcorn, O.D.
Title
Secretary/Treasurer
Phone
(402) 721-8823

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1085 NE Primary

Addresses

Primary practice location

2921 N Clarkson St
Fremont, NE 68025-2371

Mailing address

2921 N Clarkson St
Fremont, NE 68025-2371
Phone (402) 721-8823

Other identifiers 1

IdentifierTypeStateIssuer
10024947900MedicaidNE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100429000020 NE Part B Supplier - Clinic/Group Practice 7315074085 Receives reassigned benefits from 1 practitioner
Practice locations: Fremont, NE
O20100930041826 NE DME Supplier - Physician - Optometrist 7315074085 Practice locations: Fremont, NE

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Bloom Optical LLC2921 N Clarkson St, Fremont, NE 68025-2371(402) 721-8823 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Mar 1, 2003

National Provider Directory

National Provider Directory

Locations

2921 N Clarkson St
Fremont, NE 68025
Phone (402) 721-8823

Practitioners & affiliated clinicians

Practitioners 1

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": "1136419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195084800000",
    "number": "1821076282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2921 N CLARKSON ST",
            "city": "FREMONT",
            "state": "NE",
            "postal_code": "680252371",
            "telephone_number": "402-721-8823",
            "fax_number": "402-721-2482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2921 N CLARKSON ST",
            "city": "FREMONT",
            "state": "NE",
            "postal_code": "680252371",
            "telephone_number": "402-721-8823",
            "fax_number": "402-721-2482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM OPTICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-05",
        "last_updated": "2007-11-15",
        "status": "A",
        "authorized_official_last_name": "ALCORN",
        "authorized_official_first_name": "STEVE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "SECRETARY/TREASURER",
        "authorized_official_telephone_number": "402-721-8823",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NE",
            "license": "1085",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10024947900",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.