MEDICARE: JORGE LUIS SOLORZANO O.D.

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	152W00000X	Optometrist	2432	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2324338	OTHER	OK	UNITED HEALTHCARE
2	7200451	OTHER	OK	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952304586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE LUIS SOLORZANO O.D.

Provider Business Mailing Address
First Line	:	1414 ARLINGTON ST
Second Line	:	STE 1400
City	:	ADA
State	:	OK
Zip	:	74820-2643
Country	:	US
Telephone Number	:	580-332-1880
Fax Number	:	580-332-2214

Provider Business Practice Location Address
First Line	:	1414 ARLINGTON ST
Second Line	:	STE 1400
City	:	ADA
State	:	OK
Zip	:	74820-2643
Country	:	US
Telephone Number	:	580-332-1880
Fax Number	:	580-332-2214

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	05/15/2008

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