Individual
MR. MICHAEL SCOTT BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1020 WOODMAN DR STE 105, DAYTON, OH 45432-1446
(937) 723-7772
(937) 226-9605
Mailing address
1020 WOODMAN DR STE 105, DAYTON, OH 45432-1446
(937) 723-7772
(937) 226-9605
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
207W00000X
OH
207WX0110X
Pediatric Ophthalmology and Strabismus Specialist Physician
Primary
35066075B
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2099223
—
OH
05
—
9111115
—
OH
Enumeration date
05/08/2006
Last updated
10/28/2021
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