Larry Martin Bloom, O.D.
Optometrist in Sylvania, OH. Individual provider (NPI-1).
NPI number1144400763
StatusActive
Last updated in NPPESMar 9, 2009
Details
- NPI
- 1144400763
- Entity type
- Individual (NPI-1)
- Name
- Larry Martin Bloom
- Credential
- O.D.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Nov 12, 2007
- Last updated
- Mar 9, 2009
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | 2757/T1242 | OH | Yes |
Practice location
5600 Monroe StSylvania, OH 43560
Phone 419-882-8467 · Fax 419-882-8951
Mailing address
5600 Monroe StSylvania, OH 43560-2731
Phone 419-882-8467 · Fax 419-882-8951
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