Provider Demographics
NPI:1619150976
Name:DR PATRICIA A. HALLER OPTOMETRIST INC
Entity Type:Organization
Organization Name:DR PATRICIA A. HALLER OPTOMETRIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-774-4616
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-0095
Mailing Address - Country:US
Mailing Address - Phone:740-774-4616
Mailing Address - Fax:740-779-3856
Practice Address - Street 1:59 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-3104
Practice Address - Country:US
Practice Address - Phone:740-774-4616
Practice Address - Fax:740-779-3856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4841152W00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0005791631OtherAETNA MEDICARE
22-01034OtherUNITED HEALTHCARE
OH2013921Medicaid
OH=========OtherVISION SERVICE PLAN
OHDN9363Medicare PIN
OH2013921Medicaid