Provider Demographics
NPI:1952304586
Name:SOLORZANO, JORGE LUIS (OD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:LUIS
Last Name:SOLORZANO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 ARLINGTON ST
Mailing Address - Street 2:STE 1400
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-2643
Mailing Address - Country:US
Mailing Address - Phone:580-332-1880
Mailing Address - Fax:580-332-2214
Practice Address - Street 1:1414 ARLINGTON ST
Practice Address - Street 2:STE 1400
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2643
Practice Address - Country:US
Practice Address - Phone:580-332-1880
Practice Address - Fax:580-332-2214
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2432152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2324338OtherUNITED HEALTHCARE
OK7200451OtherAETNA
OK200061320AMedicaid
OK2324338OtherUNITED HEALTHCARE
OK200061320AMedicaid
OKP00242312Medicare PIN