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 | | TUV0038391 | NEW YORK | 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 | NY3839 | OTHER | NEW YORK | EYEMED |
| 2 | 7209491 | OTHER | NEW YORK | INDEPENDENT HEALTH |
| 3 | 410047245 | MEDICARE PIN | NEW YORK | |
| 4 | 161150836 | OTHER | NEW YORK | TRICARE |
| 5 | 00020345201 | OTHER | NEW YORK | UNIVERA |
| 6 | 15568 | OTHER | NEW YORK | SPECTERA |
| 7 | 161150836 | OTHER | NEW YORK | EMPIRE |
| 8 | 330823 | OTHER | NEW YORK | NATIONAL VISION ADMINISTR |
| 9 | J400035960 | MEDICARE PIN | NEW YORK | |
| 10 | 081141 | MEDICARE PIN | NEW YORK | |
| 11 | 000300107001 | OTHER | NEW YORK | BLUE CROSS BLUE SHIELD |
| 12 | 7166491010 | OTHER | NEW YORK | VISION SERVICE PLAN |
| 13 | 612 | OTHER | NEW YORK | DAVIS VISION |
| 14 | NY3839 | OTHER | NEW MEXICO | VISION BENEFITS OF AMERIC |
| 15 | T88395 | MEDICARE UPIN | NEW YORK | |
| 16 | 0771550001 | MEDICARE NSC | NEW YORK | |
