Individual provider Active NPI

Zack Cosgrove Solomon, OD

  • Optometrist
  • Baltimore, MD
National Provider Identifier
1629746052
Registry record updated Oct 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2817 Issued in MD
Practice address
1029 Light St
Baltimore, MD 21230-4017
Phone
(410) 752-8208
Fax
(410) 752-7144
NPI assigned
Aug 31, 2021
Last updated
Oct 14, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2817 MD Primary

Addresses

Primary practice location

1029 Light St
Baltimore, MD 21230-4017

Mailing address

625 Savage St
Baltimore, MD 21224-4620
Phone (240) 412-5721

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211020001858 MD Practitioner - Optometry 2860880069 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aeg Maryland Professional LLCGroup PAC ID 7618316902, 20 clinicians
Federal Hill Practice LLCGroup PAC ID 8921363078, 2 clinicians

Practice addresses (Care Compare)

1029 Light St
Baltimore, MD 21230-4017
Phone (410) 752-8208

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2817MDMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Federal Hill Practice LLC Optometrist CurrentSince Aug 30, 2021 Accepting new patients
Aeg Maryland Professional LLC Optometrist CurrentSince Feb 3, 2026 Accepting new patients

Locations

1029 Light St
Baltimore, MD 21230
Phone (410) 752-8208

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1630368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634169600000",
    "number": "1629746052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 SAVAGE ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212244620",
            "telephone_number": "240-412-5721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1029 LIGHT ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212304017",
            "telephone_number": "410-752-8208",
            "fax_number": "410-752-7144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOLOMON",
        "first_name": "ZACK",
        "middle_name": "COSGROVE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-31",
        "last_updated": "2021-10-14",
        "certification_date": "2021-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "2817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.