Provider Demographics
NPI:1427183359
Name:OPTOMETRISTS OF LANSING PC
Entity Type:Organization
Organization Name:OPTOMETRISTS OF LANSING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-485-2213
Mailing Address - Street 1:2117 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3231
Mailing Address - Country:US
Mailing Address - Phone:517-485-2213
Mailing Address - Fax:517-485-2220
Practice Address - Street 1:2117 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3231
Practice Address - Country:US
Practice Address - Phone:517-485-2213
Practice Address - Fax:517-485-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRC002397152W00000X
MIKM002606152W00000X
MISE003722152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1548242480OtherNPI NUMBER
MI1902895295OtherDR ESTES NPI
MI1336130012OtherDR MARTON NPI
MI5060600Medicaid
MI3120432Medicaid
MI5060594Medicaid
MIU53723Medicare UPIN
MI1548242480OtherNPI NUMBER
MIT32891Medicare UPIN
MI3120432Medicaid
MI5060600Medicaid