Individual
LARRY MARTIN BLOOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
5600 MONROE ST, SYLVANIA, OH 43560
(419) 882-8467
(419) 882-8951
Mailing address
5600 MONROE ST, SYLVANIA, OH 43560-2731
(419) 882-8467
(419) 882-8951
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2757/T1242
OH
Other
Enumeration date
11/12/2007
Last updated
03/09/2009
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