Basic Information
| Provider Information | |||||||||
| NPI: | 1801848148 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KALINA | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 W UNIVERSITY DR STE 1 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852015833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808330014 | ||||||||
| FaxNumber: | 4808357551 | ||||||||
| Practice Location | |||||||||
| Address1: | 160 W UNIVERSITY DR STE 1 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808330014 | ||||||||
| FaxNumber: | 4808357551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 06/06/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1501 | AZ | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 046009205 | 05 | IL | MEDICAID |