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 | 27OA00435400 | NEW JERSEY | No |
| 2 | 152WP0200X | Optometrist | Pediatrics | 27OA00435400 | NEW JERSEY | No |
| 3 | 152WS0006X | Optometrist | Sports Vision | 27OA00435400 | NEW JERSEY | No |
| 4 | 152WV0400X | Optometrist | Vision Therapy | 27OA00435400 | NEW JERSEY | No |
| 5 | 152W00000X | Optometrist | | 27OA00435400 | 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 | 2K7427 | OTHER | NEW JERSEY | HEALTHNET IND ID NUMBER |
| 2 | P466316 | OTHER | NEW JERSEY | OXFORD IND ID NUMBER |
| 3 | 01000500200 | OTHER | NEW JERSEY | AMERICHOICE |
| 4 | 201330164 | OTHER | NEW JERSEY | HORIZON BC/BS ID NUMBER |
| 5 | 2341813000 | OTHER | NEW JERSEY | AMERIHEALTH GROUP ID NUMB |
| 6 | 30903 | OTHER | NEW JERSEY | GROUP VISION ASSOC ID NUM |
| 7 | 4502254 | OTHER | NEW JERSEY | AETNA (NON-HMO) |
| 8 | 50596 | OTHER | NEW JERSEY | DAVIS VISION ID NUMBER |
| 9 | 3275906 | MEDICAID | NEW JERSEY | |
| 10 | 3242884 | OTHER | NEW JERSEY | CIGNA IND ID NUMBER |
| 11 | 201330164 | OTHER | NEW JERSEY | QUALCARE GROUP ID NUMBER |
| 12 | U11789 | MEDICARE UPIN | NEW JERSEY | |
| 13 | 310954 | OTHER | NEW JERSEY | NATIONAL VISION ADMIN ID |
| 14 | 3628546 | OTHER | NEW JERSEY | AETNA (HMO) |
| 15 | 0055395 | MEDICAID | NEW JERSEY | |
| 16 | 0075755000 | OTHER | NEW JERSEY | AMERIHEALTH IND PROV ID |
| 17 | G3410217 | OTHER | NEW JERSEY | OXFORD GROUP ID NUMBER |
| 18 | 60016235 | OTHER | NEW JERSEY | HORIZON NJ HEALTH |
| 19 | 088581 | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | GROUP ID NUMBER |
