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 | | 1539 | KANSAS | 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 | 5109645 | OTHER | KANSAS | AETNA |
| 2 | 25757025 | OTHER | MISSOURI | BCBSKC FOR EYE ASSOCIATES OF OLATHE |
| 3 | R188660 | OTHER | KANSAS | MEDICARE PART B FOR EYE ASSOCIATES OF OLATHE |
| 4 | U73047 | MEDICARE UPIN | | |
| 5 | R188660 | MEDICARE PIN | KANSAS | |
| 6 | 410043137 | OTHER | KANSAS | RR MEDICARE FOR EYE ASSOCIATES OF OVERLAND PARK |
| 7 | R178660 | MEDICARE PIN | KANSAS | |
| 8 | 25757035 | OTHER | MISSOURI | BCBSKC FOR EYE ASSOCIATES OF SHAWNEE |
| 9 | R198660 | MEDICARE PIN | KANSAS | |
| 10 | 25757045 | OTHER | MISSOURI | BCBSKC FOR EYE ASSOCIATES OF LEAWOOD |
| 11 | R178660 | OTHER | KANSAS | MEDICARE PART B FOR EYE ASSOCIATES OF SHAWNEE |
| 12 | 25757015 | OTHER | MISSOURI | BCBSKC FOR EYE ASSOCIATES OF OVERLAND PARK |
| 13 | KA1109006 | OTHER | | MEDICARE PART B FOR EYE ASSOCIATES OF LEAWOOD |
| 14 | R198660 | OTHER | KANSAS | MEDICARE PART B FOR EYE ASSOCIATES OF OVERLAND PARK |