Basic Information
Provider Information
NPI: 1245527266
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SOLEN
FirstName: AARON
MiddleName: TODD
NamePrefix:  
NameSuffix:  
Credential: O.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 38
Address2:  
City: SACATON
State: AZ
PostalCode: 851470001
CountryCode: US
TelephoneNumber: 5207962692
FaxNumber:  
Practice Location
Address1: 483 W SEED FARM RD
Address2:  
City: SACATON
State: AZ
PostalCode: 851475000
CountryCode: US
TelephoneNumber: 6025281200
FaxNumber: 6025281255
Other Information
ProviderEnumerationDate: 06/29/2011
LastUpdateDate: 09/14/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/14/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152W00000X1841AZY Eye and Vision Services ProvidersOptometrist 

No ID Information.


Home