MEDICARE: OLAYEMI VICTORIA SWINDELL O.D.

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	OEG0003003	PA

General Provider Information

NPI Number	:	1528469384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLAYEMI VICTORIA SWINDELL O.D.

Provider Business Mailing Address
First Line	:	2745 MAPLEWOOD MEWS
Second Line	:
City	:	AUDUBON
State	:	PA
Zip	:	19403-1946
Country	:	US
Telephone Number	:	301-613-9336
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 EVERGREEN DR
Second Line	:	SUITE 117
City	:	GLEN MILLS
State	:	PA
Zip	:	19342-1056
Country	:	US
Telephone Number	:	610-558-9803
Fax Number	:	610-558-7612

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2014
Last Update Date	:	12/31/2023

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