Provider Demographics
NPI:1942231758
Name:SOLL EYE PC OF PA
Entity Type:Organization
Organization Name:SOLL EYE PC OF PA
Other - Org Name:OPTICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SOLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-288-5000
Mailing Address - Street 1:5001 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-2619
Mailing Address - Country:US
Mailing Address - Phone:215-288-5000
Mailing Address - Fax:215-744-1233
Practice Address - Street 1:5001 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-2619
Practice Address - Country:US
Practice Address - Phone:215-288-5000
Practice Address - Fax:215-744-1233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001731152W00000X
207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009231760017Medicaid
PA0603090001OtherDURABLE MEDEICAL EQUIPMEN
PA16795OtherSPECTERA GROUP #
PAPA10000OtherVBA GROUP #
PA16787OtherSPECTERA GROUP #
PA0009231760014Medicaid
PA32060OtherDAVIS VISION FR GROUP #
PA0009231760014Medicaid