Provider Demographics
NPI:1295738847
Name:CORRIGAN, GENEVIEVE KIM (OD)
Entity type:Individual
Prefix:DR
First Name:GENEVIEVE
Middle Name:KIM
Last Name:CORRIGAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2209 FRANCISCO DR STE 150
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-3805
Mailing Address - Country:US
Mailing Address - Phone:916-933-5535
Mailing Address - Fax:916-933-9168
Practice Address - Street 1:2209 FRANCISCO DR STE 150
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-3805
Practice Address - Country:US
Practice Address - Phone:916-933-5535
Practice Address - Fax:916-933-9168
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA09848TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13457OtherMES
CA49855OtherHEALTH NET PPO
CA49855OtherSAFEGUARD PPO
CA45339OtherHEALTH NET HMO
CA45339OtherSAFEGUARD HMO
CA7579166OtherAETNA EPO,PPO,MC
CA116335OtherECPA
CA0691264OtherAETNA HMO
CA45339OtherHEALTH NET HMO
CASD0098480Medicare ID - Type Unspecified