Provider Demographics
NPI:1689890485
Name:SOLOMON OPTICAL COMPANY INC
Entity Type:Organization
Organization Name:SOLOMON OPTICAL COMPANY INC
Other - Org Name:SOLOMON OPTICAL COMPANY/SOLOMON OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:SOLOMON
Authorized Official - Last Name:FISCHBEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-332-0606
Mailing Address - Street 1:625 MARQUETTE AVE
Mailing Address - Street 2:# 235 SKYWAY LEVEL
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-2308
Mailing Address - Country:US
Mailing Address - Phone:612-332-0606
Mailing Address - Fax:
Practice Address - Street 1:625 MARQUETTE AVE
Practice Address - Street 2:# 235 SKYWAY LEVEL
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2308
Practice Address - Country:US
Practice Address - Phone:612-332-0606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN=========OtherFEDERAL IS NUMBER