Provider Demographics
NPI:1366413379
Name:STALLINGS, HARRIET G (OD)
Entity type:Individual
Prefix:DR
First Name:HARRIET
Middle Name:G
Last Name:STALLINGS
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 1:10130 WARNER AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1619
Mailing Address - Country:US
Mailing Address - Phone:714-965-5130
Mailing Address - Fax:714-965-8265
Practice Address - Street 1:10130 WARNER AVE
Practice Address - Street 2:SUITE J
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1619
Practice Address - Country:US
Practice Address - Phone:714-965-5130
Practice Address - Fax:714-965-8265
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8592T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8626328Medicaid
CA8626328Medicaid
CAOP8592Medicare ID - Type Unspecified