Provider Demographics
NPI:1386260198
Name:SOLIS, MEGAN MACKENZIE (OD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MACKENZIE
Last Name:SOLIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1872 NORWOOD DR STE 200
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3099
Mailing Address - Country:US
Mailing Address - Phone:817-540-6060
Mailing Address - Fax:
Practice Address - Street 1:1872 NORWOOD DR STE 200
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3099
Practice Address - Country:US
Practice Address - Phone:817-540-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9954152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program