MEDICARE: SOLL EYE PC OF PA

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
2	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00053129004	OTHER	PA	IBC KEYSTONE
2	27807	OTHER	PA	HEALTH PARTNERS
3	50081	OTHER	PA	AETNA HMO
4	1027255	OTHER	PA	KEYSTONE MERCY
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	00039405	OTHER	PA	HIGHMARK BS
7	4617586	OTHER	PA	AETNA PPO

General Provider Information

NPI Number	:	1285628636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLL EYE PC OF PA

Provider Business Mailing Address
First Line	:	5001 FRANKFORD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-2619
Country	:	US
Telephone Number	:	215-288-5000
Fax Number	:	215-744-1233

Provider Business Practice Location Address
First Line	:	10160 BUSTLETON AVE
Second Line	:	SUITE F
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-3749
Country	:	US
Telephone Number	:	215-934-7655
Fax Number	:	215-934-6278

Authorized Official
Title or Position	:	M.D.
Name	:	DR. STEPHEN M SOLL
Credential	:	M.D.
Telephone Number	:	215-288-5000

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	10/22/2007

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Directions to “SOLL EYE PC OF PA ” Practice Location

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