Organization
LARRY-W-BLOOMINGBURG-OD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY W BLLOMINGBURG O.D. (OWNER)
(731) 989-3511
Entity
Organization
Contact information
Practice address
138 S WASHINGTON AVE, HENDERSON, TN 38340-2323
(731) 989-3511
(731) 989-3515
Mailing address
138 S WASHINGTON AVE, HENDERSON, TN 38340-2323
(731) 989-3511
(731) 989-3515
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
573
TN
Other
Enumeration date
03/06/2008
Last updated
03/06/2008
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