Provider Demographics
NPI:1548242480
Name:CARRIGAN, RICHARD TRACY (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:TRACY
Last Name:CARRIGAN
Suffix:
Gender:M
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:PO BOX 208177
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-8177
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:
Practice Address - Street 1:2117 E GRAND RIV
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
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRC002397152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900C36539OtherBCBS OF MICHIGAN
MI945060600Medicaid
MIT32887Medicare UPIN
MI900C36539OtherBCBS OF MICHIGAN