Provider Demographics
NPI:1245326602
Name:SOLOMON, STEPHEN EDWARD (DO)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:EDWARD
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 MEMORIAL PKWY SW STE 200
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6901
Mailing Address - Country:US
Mailing Address - Phone:256-533-0315
Mailing Address - Fax:
Practice Address - Street 1:1150 EAGLETREE LN SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6446
Practice Address - Country:US
Practice Address - Phone:256-533-8801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8837207W00000X
AL2183207WX0109X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1245326602Medicaid
E85438Medicare UPIN
CACF277ZMedicare PIN