Individual
DR. VINITA MARY SOLOMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541
Mailing address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046010132
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046010132
—
IL
01
—
R02624
MEDICARE PTAN
IL
Enumeration date
07/21/2007
Last updated
01/19/2009
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