Provider Demographics
NPI:1902865686
Name:SOLOMON, RONALD DAVID (OD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:DAVID
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:RONALD
Other - Middle Name:D
Other - Last Name:SOLOMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2145 ACADEMY CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1658
Mailing Address - Country:US
Mailing Address - Phone:719-574-7000
Mailing Address - Fax:719-597-1712
Practice Address - Street 1:2145 ACADEMY CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1658
Practice Address - Country:US
Practice Address - Phone:719-574-7000
Practice Address - Fax:719-597-1712
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO715152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08007155Medicaid
CO08007155Medicaid
COCF4523Medicare PIN