MEDICARE: MR. PRESTON LEE SOLOMON BHRS

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	2255R0406X	Blind Rehabilitation Specialist/Technologist

General Provider Information

NPI Number	:	1336582287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PRESTON LEE SOLOMON BHRS

Provider Business Mailing Address
First Line	:	6215 NW 63RD ST
Second Line	:	APT. A
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-7515
Country	:	US
Telephone Number	:	405-713-6934
Fax Number	:	405-713-6915

Provider Business Practice Location Address
First Line	:	6215 NW 63RD ST
Second Line	:	APT. A
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-7515
Country	:	US
Telephone Number	:	405-713-6934
Fax Number	:	405-713-6915

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

Provider Enumeration Date	:	04/10/2013
Last Update Date	:	04/10/2013

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