Individual
SCOTT BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1510 N BROADWAY ST, HASTINGS, MI 49058-1007
(269) 945-2192
(269) 945-3937
Mailing address
1510 N BROADWAY ST, HASTINGS, MI 49058-1007
(269) 945-2192
(269) 945-3937
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4903603
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2813638
—
MI
Enumeration date
01/08/2007
Last updated
03/10/2009
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