1346252319 NPI number — DR. PAMELA SUE SOLLY O.D.

Table of content: FALLON D GUIN PA-S (NPI 1083280556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346252319 NPI number — DR. PAMELA SUE SOLLY O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOLLY
Provider First Name:
PAMELA
Provider Middle Name:
SUE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346252319
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
747 HIGHWAY 71 W
Provider Second Line Business Mailing Address:
SUITE A-550
Provider Business Mailing Address City Name:
BASTROP
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78602-4096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-321-3042
Provider Business Mailing Address Fax Number:
512-321-3083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
747 HIGHWAY 71 W
Provider Second Line Business Practice Location Address:
SUITE A-550
Provider Business Practice Location Address City Name:
BASTROP
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78602-4096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-321-3042
Provider Business Practice Location Address Fax Number:
512-321-3083
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  6918TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1058395 . This is a "BLUELINK" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7303862 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 152203100 . This is a "FIRST CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01040051 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 81620Q . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 930467 . This is a "BLOCK VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 32787-020 . This is a "DAVIS VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: VP17759 . This is a "GE WELLNESS" identifier . This identifiers is of the category "OTHER".
  • Identifier: TX6918 . This is a "EYEMED" identifier . This identifiers is of the category "OTHER".




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