MEDICARE: DAVID SOLIS LICENSED OPTICIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	DO5176	FL

General Provider Information

NPI Number	:	1386845139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID SOLIS LICENSED OPTICIAN

Provider Business Mailing Address
First Line	:	721 S ORANGE BLOSSOM TRL
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32703-6557
Country	:	US
Telephone Number	:	407-880-0335
Fax Number	:	407-880-6782

Provider Business Practice Location Address
First Line	:	721 S ORANGE BLOSSOM TRL
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32703-6557
Country	:	US
Telephone Number	:	407-880-0335
Fax Number	:	407-880-6782

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	07/09/2007

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