Provider Demographics
NPI:1649746702
Name:SOLA PROSTHETICS, INC
Entity Type:Organization
Organization Name:SOLA PROSTHETICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:GUICHET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-954-7954
Mailing Address - Street 1:2461 RANCHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-6031
Mailing Address - Country:US
Mailing Address - Phone:214-960-9190
Mailing Address - Fax:
Practice Address - Street 1:37283 SWAMP RD UNIT 602
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3329
Practice Address - Country:US
Practice Address - Phone:225-954-7954
Practice Address - Fax:214-853-4135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-16
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier