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 | | 2212 | MINNESOTA | No |
| 2 | 152W00000X | Optometrist | | 2189 | MINNESOTA | 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 | 115713 | OTHER | MINNESOTA | UCARE GARETH |
| 2 | 169323900 | MEDICAID | MINNESOTA | |
| 3 | 0914860001 | MEDICARE NSC | MINNESOTA | |
| 4 | 4C069HA | OTHER | MINNESOTA | BCBSM GARETH |
| 5 | 2200447 | OTHER | MINNESOTA | MEDICA |
| 6 | 409523500 | MEDICAID | MINNESOTA | |
| 7 | 4C067PA | OTHER | MINNESOTA | BCBSM GROUP |
| 8 | 2200104 | OTHER | MINNESOTA | MEDICA OPTICAL |
| 9 | 06844 | MEDICARE ID-TYPE UNSPECIFIED | MINNESOTA | LOCATION NUMBER |
| 10 | 4C068SO | OTHER | MINNESOTA | BCBSM ALAINA |
| 11 | 122609 | OTHER | MINNESOTA | UCARE ALAINA |
| 12 | U02805 | MEDICARE UPIN | MINNESOTA | |
| 13 | 4C070PA | OTHER | MINNESOTA | BCBSM OPTICAL |
| 14 | 1011298 | OTHER | MINNESOTA | PREFERRED ONE ALAINA |
| 15 | T82063 | MEDICARE UPIN | MINNESOTA | |
| 16 | 410030370 | MEDICARE ID-TYPE UNSPECIFIED | MINNESOTA | RAILROAD MEDICARE ALAINA |
| 17 | 1011297 | OTHER | MINNESOTA | PREFERRED ONE GARETH |
| 18 | 123247 | OTHER | MINNESOTA | UCARE GROUP |
| 19 | 419000274 | MEDICARE ID-TYPE UNSPECIFIED | MINNESOTA | PART B ALAINA |
| 20 | 419000273 | MEDICARE ID-TYPE UNSPECIFIED | MINNESOTA | MEDICARE PART B GARETH |
