Healthcare Provider Details

I. General information

NPI: 1063760601
Provider Name (Legal Business Name): SOLOMON EYE ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13156 MIDLOTHIAN TPKE
MIDLOTHIAN VA
23113-4245
US

IV. Provider business mailing address

13156 MIDLOTHIAN TPKE
MIDLOTHIAN VA
23113-4245
US

V. Phone/Fax

Practice location:
  • Phone: 804-378-2303
  • Fax: 804-378-1641
Mailing address:
  • Phone: 804-378-2303
  • Fax: 804-378-1641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618002154
License Number StateVA

VIII. Authorized Official

Name: MICHELLE SOLOMON
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 804-378-2303