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

Table of content: DR. PAMELA SUE SOLLY O.D. (NPI 1346252319)

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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