Provider Demographics
NPI:1679605943
Name:BLOOMINGCAMP OPTOMETRY A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:BLOOMINGCAMP OPTOMETRY A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONI
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLOOMINGCAMP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:925-454-1598
Mailing Address - Street 1:2205 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4552
Mailing Address - Country:US
Mailing Address - Phone:925-454-1598
Mailing Address - Fax:925-454-1593
Practice Address - Street 1:2205 4TH ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4552
Practice Address - Country:US
Practice Address - Phone:925-454-1598
Practice Address - Fax:925-454-1593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8631T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty