Provider Demographics
NPI:1528042447
Name:SOLLEY, WAYNE A (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:A
Last Name:SOLLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650037
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0037
Mailing Address - Country:US
Mailing Address - Phone:214-696-2008
Mailing Address - Fax:
Practice Address - Street 1:801 W RANDOL MILL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2505
Practice Address - Country:US
Practice Address - Phone:817-261-9625
Practice Address - Fax:817-261-9586
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7398207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116238005Medicaid
TX116238006Medicaid
TX116238007Medicaid
TX116238004Medicaid
TX8G0130Medicare PIN
TX8G0128Medicare PIN
TX8G0129Medicare PIN
TX116238006Medicaid
TX116238004Medicaid
TX8J1404Medicare PIN