Provider Demographics
NPI:1073941381
Name:M KATHLEEN CARRIKER M.D.,P.C.
Entity Type:Organization
Organization Name:M KATHLEEN CARRIKER M.D.,P.C.
Other - Org Name:RYAN CARRIKER EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:CARRIKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PC
Authorized Official - Phone:602-956-7414
Mailing Address - Street 1:3125 N 32ND ST
Mailing Address - Street 2:100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-6281
Mailing Address - Country:US
Mailing Address - Phone:602-956-7414
Mailing Address - Fax:602-957-3227
Practice Address - Street 1:3125 N 32ND ST
Practice Address - Street 2:100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-6281
Practice Address - Country:US
Practice Address - Phone:602-956-7414
Practice Address - Fax:602-957-3227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5301207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ248098Medicaid
AZ248098Medicaid
AZZ489400687Medicare PIN