MEDICARE: JEFFREY M BROSOF OD

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	:	1730171323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY M BROSOF OD

Provider Business Mailing Address
First Line	:	8614 WESTWOOD CENTER DR FL 9
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-2442
Country	:	US
Telephone Number	:	703-847-8899
Fax Number	:

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

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	11/11/2025

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