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 | | | 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 | 0020592000 | OTHER | PENNSYLVANIA | KEYSTONE EAST GROUP ID# |
| 2 | 5586009 | OTHER | PENNSYLVANIA | AETNA TRADITIONAL/PPO |
| 3 | 0020592000 | OTHER | PENNSYLVANIA | INDEPENDENCE BC/BS |
| 4 | 02525100 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS GRP ID |
| 5 | 54384 | OTHER | PENNSYLVANIA | DAVIS AFFINITY |
| 6 | 70467 | OTHER | PENNSYLVANIA | HEALTH AMERICA GRP ID # |
| 7 | 338133 | OTHER | PENNSYLVANIA | HEALTH AMERICA/HEALTH ASSURANCE |
| 8 | 429305 | OTHER | PENNSYLVANIA | HIGHMARK GROUP ID # |
| 9 | 0020592000 | OTHER | PENNSYLVANIA | AMERIHEALTH GROUP ID # |
| 10 | CM6302 | OTHER | PENNSYLVANIA | MEDICARE RAILROAD |
| 11 | 02525100 | OTHER | PENNSYLVANIA | KEYSTONE/SEN BLUE GRP ID# |
| 12 | 5586009 | OTHER | PENNSYLVANIA | AETNA/HMO |
| 13 | 29435 | OTHER | PENNSYLVANIA | SPECTERA GROUP # |
