Provider Demographics
NPI:1346252319
Name:SOLLY, PAMELA SUE (OD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:SUE
Last Name:SOLLY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:747 HIGHWAY 71 W
Mailing Address - Street 2:SUITE A-550
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-4096
Mailing Address - Country:US
Mailing Address - Phone:512-321-3042
Mailing Address - Fax:512-321-3083
Practice Address - Street 1:747 HIGHWAY 71 W
Practice Address - Street 2:SUITE A-550
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-4096
Practice Address - Country:US
Practice Address - Phone:512-321-3042
Practice Address - Fax:512-321-3083
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6918TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1058395OtherBLUELINK
7303862OtherAETNA
152203100OtherFIRST CARE
01040051OtherAMERIGROUP
TX81620QOtherBLUE CROSS BLUE SHIELD
930467OtherBLOCK VISION
32787-020OtherDAVIS VISION
VP17759OtherGE WELLNESS
TX6918OtherEYEMED