Provider Demographics
NPI:1972779817
Name:HALLING, RICKI-LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:RICKI-LEE
Middle Name:
Last Name:HALLING
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:PO BOX 3136
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86405-3136
Mailing Address - Country:US
Mailing Address - Phone:928-486-7527
Mailing Address - Fax:
Practice Address - Street 1:2730 VIA PALMA
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86406-7730
Practice Address - Country:US
Practice Address - Phone:928-486-7527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1576152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist