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 | | OPT 12886 TPA | CALIFORNIA | No |
| 2 | 152WC0802X | Optometrist | Corneal and Contact Management | OPT 12886 TPA | CALIFORNIA | No |
| 3 | 152WL0500X | Optometrist | Low Vision Rehabilitation | OPT 12886 TPA | CALIFORNIA | No |
| 4 | 152WP0200X | Optometrist | Pediatrics | OPT12886 TPA | CALIFORNIA | No |
| 5 | 152WX0102X | Optometrist | Occupational Vision | OPT 12886 TPA | CALIFORNIA | Yes |