MEDICARE: VICTORY VISION 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	156FX1800X	Optician

General Provider Information

NPI Number	:	1710107925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTORY VISION INC

Provider Business Mailing Address
First Line	:	5139 CHESTNUT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-3430
Country	:	US
Telephone Number	:	215-747-3550
Fax Number	:	215-747-3267

Provider Business Practice Location Address
First Line	:	5139 CHESTNUT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-3430
Country	:	US
Telephone Number	:	215-747-3550
Fax Number	:	215-747-3267

Authorized Official
Title or Position	:	OWNER OPTICIAN
Name	:	MR. CHRISTIAN JOYNES
Credential	:	ETC
Telephone Number	:	215-747-3550

Provider Enumeration Date	:	04/27/2007
Last Update Date	:	08/22/2020

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