1457406795 NPI number — SOLL EYE PC OF PA

Table of content: (NPI 1457406795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457406795 NPI number — SOLL EYE PC OF PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOLL EYE PC OF PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OPTICAL
Provider Other Organization Name Type Code:
5
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:
1457406795
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5001 FRANKFORD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19124-2619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-288-5000
Provider Business Mailing Address Fax Number:
215-744-1233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10160 BUSTLETON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19116-3749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-934-7655
Provider Business Practice Location Address Fax Number:
215-934-6278
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SOLL
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
215-288-5000

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG001731 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0603090004 . This is a "DURABLE MEDICAL EQUIPMENT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0009231760014 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0009231760017 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 16795 . This is a "SPECTERA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA10000 . This is a "VBA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 24609 . This is a "SPECTERA DISPENSING" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 39974 . This is a "DAVIS VISION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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