Provider Demographics
NPI:1356623946
Name:SOLIS, MELIISSA
Entity type:Individual
Prefix:
First Name:MELIISSA
Middle Name:
Last Name:SOLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:SOLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2877 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3901
Mailing Address - Country:US
Mailing Address - Phone:201-795-3434
Mailing Address - Fax:201-795-9857
Practice Address - Street 1:2877 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3901
Practice Address - Country:US
Practice Address - Phone:201-795-3434
Practice Address - Fax:201-795-9857
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00634300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist