| NPI | 1104341536 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANCE ELDEN BLOOM Optometrist/Owner 970-699-5959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO OPT.0003017) |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2022-07-21 |