Provider Demographics
NPI:1821479197
Name:DEBRA BETH SOLOMON OD PC
Entity Type:Organization
Organization Name:DEBRA BETH SOLOMON OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:516-371-2807
Mailing Address - Street 1:19 LESLIE LN
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2318
Mailing Address - Country:US
Mailing Address - Phone:516-371-2807
Mailing Address - Fax:516-371-2806
Practice Address - Street 1:605 ROCKAWAY TPKE
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1047
Practice Address - Country:US
Practice Address - Phone:516-371-2807
Practice Address - Fax:516-371-2806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005481152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty