Provider Demographics
NPI:1073595005
Name:SOELLNER, LAWRENCE GORDON (OD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:GORDON
Last Name:SOELLNER
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 1:425 W HOLMES ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62233-1331
Mailing Address - Country:US
Mailing Address - Phone:618-826-4521
Mailing Address - Fax:618-826-4520
Practice Address - Street 1:425 W HOLMES ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:IL
Practice Address - Zip Code:62233-1331
Practice Address - Country:US
Practice Address - Phone:618-826-4521
Practice Address - Fax:618-826-4520
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3979170002Medicare NSC
3979170001Medicare NSC
L86497Medicare PIN
L86507Medicare PIN
L72923Medicare PIN
3979170004Medicare NSC
3979170003Medicare NSC
3979170005Medicare NSC
L86476Medicare PIN
U01773Medicare UPIN