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 | | 6589TG | TEXAS | 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 | 0038FF | OTHER | TEXAS | GROUP & PENSION ADMINISTRATORS |
| 2 | 0038FF | OTHER | TEXAS | TEXAS TRUE CHOICE |
| 3 | 11450424 | OTHER | TEXAS | AETNA |
| 4 | 11450424 | OTHER | TEXAS | AETNA TRS CARE |
| 5 | 170498302 | MEDICAID | TEXAS | |
| 6 | 22704 | OTHER | TEXAS | ALWAYS VISION |
| 7 | 81256Q | OTHER | TEXAS | BLUE CROSS BLUE SHIELD GOVERNMENT |
| 8 | 921841 | OTHER | TEXAS | BLOCK VISION |
| 9 | 5451470001 | OTHER | TEXAS | CIGNA GOVERNMENT SERVICES |
| 10 | 60583 | OTHER | TEXAS | SAFEGUARD |
| 11 | 82840Q | OTHER | TEXAS | BCBS |
| 12 | 925395 | OTHER | TEXAS | WEB-TPA |
| 13 | TIN PLUS 015 | OTHER | TEXAS | TRICARE TC EYE JV LOCATION |
| 14 | TIN PLUS 021 | OTHER | TEXAS | TRICARE |
| 15 | 0038FF | OTHER | TEXAS | VISION CARE PLAN |
| 16 | 0038FF | OTHER | TEXAS | PRINICIPAL FINANCIAL GROUP |
| 17 | 0038FF | OTHER | TEXAS | UNITED HEALTH CARE |
| 18 | 0038FF | OTHER | TEXAS | HEALTHFIRST TPA |
| 19 | 0038FF | OTHER | TEXAS | TEXAS COMMUNITY CARE |
| 20 | 22704 | OTHER | TEXAS | NATIONAL VISION ADMINISTRATORS |
| 21 | 5451470001 | OTHER | TEXAS | STERLING OPTION I |
| 22 | 9370971 | OTHER | TEXAS | BENEFIT PLANNERS |
| 23 | 202043539 | OTHER | TEXAS | TRICARE SOUTH |
| 24 | 81256Q | OTHER | TEXAS | BLUE CROSS BLUE SHIELD |
| 25 | 9370971 | OTHER | TEXAS | PHCS |
| 26 | 0038FF | OTHER | TEXAS | SUPERIOR VISION |
| 27 | 0038FF | OTHER | TEXAS | VISION SERVICE PLAN |
| 28 | 170498303 | MEDICAID | TEXAS | |
| 29 | 5451470001 | OTHER | TEXAS | STERLING OPTION II |
| 30 | HO96271 | OTHER | TEXAS | INEGRATED HEALTH PLAN |
