MEDICARE: DR. VICTOR JAY BAROUH

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	OE4645T	PA

General Provider Information

NPI Number	:	1912021999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. VICTOR JAY BAROUH

Provider Business Mailing Address
First Line	:	8500 HENRY AVE
Second Line	:	ANDORRA SHOPPING CENTER
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-2111
Country	:	US
Telephone Number	:	215-487-2345
Fax Number	:

Provider Business Practice Location Address
First Line	:	8500 HENRY AVE
Second Line	:	ANDORRA SHOPPING CENTER
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-2111
Country	:	US
Telephone Number	:	215-487-2345
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. VICTOR JAY BAROUH
Credential	:	O.D.
Telephone Number	:	215-487-2345

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	08/22/2020

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