Provider Demographics
NPI:1699756981
Name:BLOM, THOMAS E (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:BLOM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 BEE RIDGE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-6347
Mailing Address - Country:US
Mailing Address - Phone:941-925-3937
Mailing Address - Fax:941-925-4967
Practice Address - Street 1:2450 BEE RIDGE RD
Practice Address - Street 2:SUITE A
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-6347
Practice Address - Country:US
Practice Address - Phone:941-925-3937
Practice Address - Fax:941-925-4967
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3086152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620830400Medicaid
FL620830400Medicaid
FL4390740001Medicare NSC
FL20812Medicare PIN