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 | | 3855 | MASSACHUSETTS | 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 | JOW16020 | OTHER | | BCBS PPD |
| 2 | 763552 | OTHER | | SECURE HORIZONS /ECE |
| 3 | CE5062 | OTHER | | RAILROAD MEDICARE |
| 4 | 150576 | OTHER | | PILGRIM HEALTH CARE |
| 5 | 160676 | OTHER | | HARVARD PILGRIM HMO |
| 6 | 763552 | OTHER | | TUFTS ASSOCIATED HEALTH |
| 7 | 0337901 | MEDICAID | MASSACHUSETTS | |
| 8 | 763662 | OTHER | | SECURE HORIZONS/NEEC |
| 9 | 009318 | OTHER | | NEIGHBORHOOD HEALTH |
| 10 | 763552 | OTHER | | TUFTS PPO |
| 11 | 0026613 | OTHER | | NEIGHBORHOOD HEALTH |
| 12 | JOW1602B | OTHER | RHODE ISLAND | BLUE SHIELD |
| 13 | 150576 | OTHER | | HARVARD COMM HEALTH |
| 14 | 763552 | OTHER | | TUFTS TOTAL HEALTH PLAN |
| 15 | JOW16028 | OTHER | | BLUE SHIELD |
| 16 | U56948 | MEDICARE UPIN | | |
| 17 | B20953401 | OTHER | | CIGNA |
| 18 | 497918 | OTHER | | AETNA HMO |
| 19 | JOW16028 | OTHER | | HMO BLUE |
