Provider Demographics
NPI:1386704906
Name:DIANA L. CARRIGER OPTOMETRIST LLC
Entity type:Organization
Organization Name:DIANA L. CARRIGER OPTOMETRIST LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:785-584-6200
Mailing Address - Street 1:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:ROSSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66533-0235
Mailing Address - Country:US
Mailing Address - Phone:785-584-6200
Mailing Address - Fax:785-584-6200
Practice Address - Street 1:105 POTTAWATOMIE ST
Practice Address - Street 2:
Practice Address - City:ROSSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66533-9780
Practice Address - Country:US
Practice Address - Phone:785-584-6200
Practice Address - Fax:785-584-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1065-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0599730002OtherMEDICARE NSM
KS0599730002OtherMEDICARE NSM