MEDICARE: ANDORRA OPTOMETRICS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG000904	PA

General Provider Information

NPI Number	:	1134174477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDORRA OPTOMETRICS, INC.

Provider Business Mailing Address
First Line	:	6778 RIDGE AVE
Second Line	:	PENNSYLVANIA OPTOMETRICS
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-2487
Country	:	US
Telephone Number	:	215-483-1636
Fax Number	:

Provider Business Practice Location Address
First Line	:	6778 RIDGE AVE FL-1
Second Line	:	PENNSYLVANIA OPTOMETRICS
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-2487
Country	:	US
Telephone Number	:	215-483-1636
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JEFFREY BROSOF
Credential	:	OD
Telephone Number	:	215-483-1636

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	05/25/2022

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