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 | 152WC0802X | Optometrist | Corneal and Contact Management | TA1714 | MARYLAND | No |
| 2 | 152WL0500X | Optometrist | Low Vision Rehabilitation | TA1714 | MARYLAND | No |
| 3 | 152WP0200X | Optometrist | Pediatrics | TA1714 | MARYLAND | No |
| 4 | 152WS0006X | Optometrist | Sports Vision | TA1714 | MARYLAND | No |
| 5 | 152WV0400X | Optometrist | Vision Therapy | TA1714 | MARYLAND | No |
| 6 | 152WX0102X | Optometrist | Occupational Vision | TA1714 | MARYLAND | No |
| 7 | 152W00000X | Optometrist | | TA1714 | MARYLAND | 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 | F534 | OTHER | MARYLAND | FEDERAL BLUE CROSS |
| 2 | 550003600 | MEDICAID | MARYLAND | |
| 3 | 33606 | OTHER | MARYLAND | AVEISIS PROVIDER NUMBER |
| 4 | F534-001 | OTHER | MARYLAND | BLUE CROSS BLUE CHOICE |
| 5 | MD1714 | OTHER | MARYLAND | EYEMED VISION CARE |
| 6 | V03899 | MEDICARE UPIN | MARYLAND | |
| 7 | 2169 | OTHER | MARYLAND | BALTIMORE CITY VISION PLA |
| 8 | 4106021567 | OTHER | MARYLAND | VSP IDENTIFIER NUMBER |
| 9 | 61279002 | OTHER | MARYLAND | BLUE CROSS BLUE SHIELD |
| 10 | 3303001 | OTHER | MARYLAND | AETNA |
| 11 | 210461 | OTHER | MARYLAND | NATIONAL VISION ADMINISTR |
