Provider Demographics
NPI:1295894962
Name:KOLLING-RICKARDS, CAROL A (OD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:KOLLING-RICKARDS
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 1:1320 TORRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-5512
Mailing Address - Country:US
Mailing Address - Phone:708-868-5190
Mailing Address - Fax:708-868-3232
Practice Address - Street 1:1320 TORRENCE AVE
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5512
Practice Address - Country:US
Practice Address - Phone:708-868-5190
Practice Address - Fax:708-868-3232
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-007843152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
579270007Medicare PIN
IL579270007Medicare PIN
ILU28090Medicare UPIN