Provider Demographics
NPI: | 1316906050 |
---|---|
Name: | CARRIGER, DIANA LIU (OD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | DIANA |
Middle Name: | LIU |
Last Name: | CARRIGER |
Suffix: | |
Gender: | F |
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: | 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 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-03-21 |
Last Update Date: | 2023-03-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KS | 1065-3 | 152W00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 152W00000X | Eye and Vision Services Providers | Optometrist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KS | 410048252 | Other | RAILROAD MEDICARE |
KS | 410048252 | Other | RAILROAD MEDICARE |
KS | 0599730002 | Medicare NSC | |
KS | MC0304105 | Other | DEA |
KS | 049702 | Medicare PIN | |
KS | 0599730001 | Medicare NSC | |
KS | 515480 | Medicare PIN |