Provider Demographics
NPI:1457322455
Name:BAROUH, VICTOR JAY (OD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:JAY
Last Name:BAROUH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 HENRY AVE
Mailing Address - Street 2:ANDORRA SHOPPING CENTER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2111
Mailing Address - Country:US
Mailing Address - Phone:215-487-2345
Mailing Address - Fax:215-487-2346
Practice Address - Street 1:8500 HENRY AVE
Practice Address - Street 2:ANDORRA SHOPPING CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-2111
Practice Address - Country:US
Practice Address - Phone:215-487-2345
Practice Address - Fax:215-487-2346
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-28
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE4656T152W00000X
PAOE004656T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABA288059Medicare ID - Type Unspecified