MEDICARE: MICHELLE SOLOMON 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	152WC0802X	Corneal and Contact Management Optometrist	0618002154	VA
2	152W00000X	Optometrist	0618002154	VA

General Provider Information

NPI Number	:	1093078065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE SOLOMON O.D.

Provider Business Mailing Address
First Line	:	13156 MIDLOTHIAN TPKE
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-4245
Country	:	US
Telephone Number	:	804-378-2303
Fax Number	:	804-378-1641

Provider Business Practice Location Address
First Line	:	13156 MIDLOTHIAN TPKE
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-4245
Country	:	US
Telephone Number	:	804-378-2303
Fax Number	:	804-378-1641

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

Provider Enumeration Date	:	06/24/2012
Last Update Date	:	07/21/2022

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