Provider Demographics
NPI:1518969047
Name:SOLTIS, GERALD G (OD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:G
Last Name:SOLTIS
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 1:214 W NEW CASTLE ST
Mailing Address - Street 2:
Mailing Address - City:ZELIENOPLE
Mailing Address - State:PA
Mailing Address - Zip Code:16063-1154
Mailing Address - Country:US
Mailing Address - Phone:724-452-6675
Mailing Address - Fax:724-452-6607
Practice Address - Street 1:214 W NEW CASTLE ST
Practice Address - Street 2:
Practice Address - City:ZELIENOPLE
Practice Address - State:PA
Practice Address - Zip Code:16063-1154
Practice Address - Country:US
Practice Address - Phone:724-452-6675
Practice Address - Fax:724-452-6607
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001099152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA064556Medicare PIN
PA0612100001Medicare NSC