Provider Demographics
NPI:1447984281
Name:PEAK, CARRIGAN RAE (OD)
Entity type:Individual
Prefix:
First Name:CARRIGAN
Middle Name:RAE
Last Name:PEAK
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 1:1537 J ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-3839
Mailing Address - Country:US
Mailing Address - Phone:812-675-0890
Mailing Address - Fax:877-642-7044
Practice Address - Street 1:1537 J ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3839
Practice Address - Country:US
Practice Address - Phone:812-675-0890
Practice Address - Fax:877-642-7044
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004344A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist