Provider Demographics
NPI:1285628636
Name:SOLL EYE PC OF PA
Entity Type:Organization
Organization Name:SOLL EYE PC OF PA
Other - Org Name:SOLL EYE, NORTHEAST DIVISION
Other - Org Type:Other Name
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SOLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-288-5000
Mailing Address - Street 1:5001 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-2619
Mailing Address - Country:US
Mailing Address - Phone:215-288-5000
Mailing Address - Fax:215-744-1233
Practice Address - Street 1:10160 BUSTLETON AVE
Practice Address - Street 2:SUITE F
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3749
Practice Address - Country:US
Practice Address - Phone:215-934-7655
Practice Address - Fax:215-934-6278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00053129004OtherIBC KEYSTONE
PA27807OtherHEALTH PARTNERS
PA50081OtherAETNA HMO
PA1027255OtherKEYSTONE MERCY
PA0009231760014Medicaid
PA00039405OtherHIGHMARK BS
PA4617586OtherAETNA PPO
PA4617586OtherAETNA PPO