Provider Demographics
NPI:1174634539
Name:DIANA L. CARRIGER OPTOMETRIST LLC
Entity Type:Organization
Organization Name:DIANA L. CARRIGER OPTOMETRIST LLC
Other - Org Name:WILLIAM A CARRIGER JR. & DIANA LIU CARRIGER PTR
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LIU
Authorized Official - Last Name:CARRIGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-234-3937
Mailing Address - Street 1:1001 SW MULVANE ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1419
Mailing Address - Country:US
Mailing Address - Phone:785-234-3937
Mailing Address - Fax:785-234-1577
Practice Address - Street 1:1001 SW MULVANE ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1419
Practice Address - Country:US
Practice Address - Phone:785-234-3937
Practice Address - Fax:785-234-1577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSCE0587OtherRAILROAD MEDICARE
KS0599730001OtherMEDICARE NSM
KSCE0587OtherRAILROAD MEDICARE
KS0599730001OtherMEDICARE NSM