Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 152W00000X | Optometrist | | 27OA00588800 | NEW JERSEY | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 20-5488615 | OTHER | NEW JERSEY | HORIZON BLUE CROSS |
| 2 | 0065307 | MEDICAID | NEW JERSEY | |
| 3 | 20-54-88615 | OTHER | NEW JERSEY | CARPENTER'S WELFARE FUND |
| 4 | 2804063 | OTHER | | UNITED HEALTH CARE |
| 5 | 223294272 | OTHER | NEW JERSEY | VISION SERVICE PLAN |
| 6 | 97453 | MEDICARE UPIN | NEW JERSEY | |
| 7 | 142-4137 | OTHER | NEW JERSEY | CIGNA PPO |
| 8 | 19821 | OTHER | NEW JERSEY | SPECTERA AMERICHOICE |
| 9 | 7901 | OTHER | NEW JERSEY | EYE MED |
| 10 | 0000097476 | OTHER | PENNSYLVANIA | OPERATING ENGINEERS |
| 11 | 1388229 | OTHER | NEW JERSEY | AETNA HMO |
| 12 | 2213488000 | OTHER | NEW JERSEY | AMERIHEALTH |
| 13 | 2213488000 | OTHER | NEW JERSEY | INDEPENDENCE BLUE CROSS |
| 14 | 7427497 | OTHER | NEW JERSEY | AETNA PPO |
| 15 | HA1527974 | OTHER | NEW JERSEY | OPTICHOICE BCBS |
| 16 | P3916732 | OTHER | | OXFORD |
| 17 | 074671 | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | MEDICARE |
| 18 | 2213488000 | OTHER | NEW JERSEY | KEYSTONE EAST MEDICAL |
| 19 | 3K4694 | OTHER | NEW JERSEY | HEALTHNET |
| 20 | P27974 | OTHER | NEW JERSEY | AMERIHEALTH ADMINISTRATOR |
