Provider Demographics
NPI:1407814361
Name:SOLAN, JONATHAN KIM (OD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:KIM
Last Name:SOLAN
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 1:1251 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 101 A
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6205
Mailing Address - Country:US
Mailing Address - Phone:610-435-5561
Mailing Address - Fax:610-435-5565
Practice Address - Street 1:1251 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 101 A
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6205
Practice Address - Country:US
Practice Address - Phone:610-435-5561
Practice Address - Fax:610-435-5565
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE0058641152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA397008OtherNVA
PASO186761OtherMEDICARE PROVIDER NUMBER
PASO186761OtherHIGHMARK BLUE SHIELD
PASO186761OtherHIGHMARK BLUE SHIELD