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 | | OEG001239 | PENNSYLVANIA | 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 | 2165780 | OTHER | PENNSYLVANIA | UNITED HEALTHCARE |
| 2 | OEG001239 | OTHER | PENNSYLVANIA | HUMANA |
| 3 | OEG001239 | OTHER | PENNSYLVANIA | LOOMIS |
| 4 | 50065146 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS/KHPC |
| 5 | 9101041 | OTHER | PENNSYLVANIA | CIGNA |
| 6 | 0966540001 | MEDICARE NSC | PENNSYLVANIA | |
| 7 | 1727232 | OTHER | PENNSYLVANIA | HIGHMARK/BLUE SHIELD |
| 8 | 2396184000 | OTHER | PENNSYLVANIA | AMERIHEALTH |
| 9 | 50065146 | OTHER | PENNSYLVANIA | KEYSTONE SENIOR BLUE |
| 10 | 7564837 | OTHER | PENNSYLVANIA | AETNA TRADITIONAL/PPO |
| 11 | OEG001239 | OTHER | PENNSYLVANIA | BERKSHIRE HEALTH PARTNERS |
| 12 | ORG001239 | OTHER | PENNSYLVANIA | DEVON |
| 13 | 2206957 | OTHER | PENNSYLVANIA | SECURE HORIZON |
| 14 | 29435/29436 | OTHER | PENNSYLVANIA | SPECTERA |
| 15 | NON PAR | OTHER | PENNSYLVANIA | DAVIS VISION |
| 16 | P00398062 | OTHER | PENNSYLVANIA | MEDICARE RAILROAD |
| 17 | 7564837 | OTHER | PENNSYLVANIA | AETNA |
| 18 | NON PAR | OTHER | PENNSYLVANIA | NVA |
| 19 | OEG001239 | OTHER | PENNSYLVANIA | CORESOURCE |
| 20 | 087780HD1 | MEDICARE PIN | PENNSYLVANIA | |
| 21 | PA12390 | OTHER | PENNSYLVANIA | VBA/VISION BENEFITS OF AMERICA |
| 22 | 1336135003 | OTHER | PENNSYLVANIA | VSP/VISION SERVICE PLAN |
| 23 | 2396184000 | OTHER | PENNSYLVANIA | INDEPENDENCE BC/BS |
| 24 | 50065146 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS/POS/PPO/TRADITIONAL |
| 25 | 54384001 | OTHER | PENNSYLVANIA | DAVIS AFFINITY |
| 26 | 50065146 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS/SB/SB PPO/HMO |
| 27 | 109527 | OTHER | PENNSYLVANIA | GEISINGER |
| 28 | 1727232 | OTHER | PENNSYLVANIA | HIGHMARK/CLASSIC/PPO/PPO BLUE |
| 29 | 2396184000 | OTHER | PENNSYLVANIA | KEYSTONE EAST |
| 30 | 2396184000 | OTHER | PENNSYLVANIA | INDEPENDENCE PERSONAL CHOICE |
| 31 | 50065146 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS |
| 32 | 7564837 | OTHER | PENNSYLVANIA | AETNA/HMO |
| 33 | V03630 | MEDICARE UPIN | PENNSYLVANIA | |
| 34 | 50065146 | OTHER | PENNSYLVANIA | KEYSTONE/CBC |
| 35 | 532616 | OTHER | PENNSYLVANIA | HEALTHAMERICA/HEALTH ASSURANCE |
