Provider Demographics
NPI: | 1689746992 |
---|---|
Name: | SOLDINGER, RICHARD (OD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | RICHARD |
Middle Name: | |
Last Name: | SOLDINGER |
Suffix: | |
Gender: | |
Credentials: | OD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 520 S PARROTT AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | OKEECHOBEE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 34974-4345 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 863-763-4334 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 520 S PARROTT AVE |
Practice Address - Street 2: | |
Practice Address - City: | OKEECHOBEE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34974-4345 |
Practice Address - Country: | US |
Practice Address - Phone: | 863-763-4334 |
Practice Address - Fax: | 863-763-3226 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-11-14 |
Last Update Date: | 2025-02-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | 1504 | 152W00000X |
FL | OPC1504 | 152W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 19301 | Other | FL MEDICARE FCSO |
FL | 0365300 | Medicaid | |
FL | 19301 | Other | FL MEDICARE FCSO |
NY | C31581 | Medicare UPIN | |
NY | 00777344 | Medicaid | |
NY | 4952510001 | Medicare NSC |