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 | 5586009 | OTHER | PENNSYLVANIA | AETNA TRADITIONAL/PPO |
| 2 | 1366404345 | OTHER | PENNSYLVANIA | BERKSHIRE HEALTH PARTNERS |
| 3 | 1366404345 | OTHER | PENNSYLVANIA | SECURE HORIZON |
| 4 | 338133 | OTHER | PENNSYLVANIA | HEALTH AMERICA/HEALTH ASS |
| 5 | 0966540001 | MEDICARE NSC | PENNSYLVANIA | |
| 6 | CM6302 | OTHER | PENNSYLVANIA | MEDICARE RAILROAD |
| 7 | 0050038 | OTHER | PENNSYLVANIA | AETNA/HMO |
| 8 | 02525100 | OTHER | PENNSYLVANIA | KEYSTONE SENIOR BLUE GROUP # |
| 9 | 1366404345 | OTHER | PENNSYLVANIA | HUMANA |
| 10 | 02525100 | OTHER | PENNSYLVANIA | CAPITOL BLUE CROSS |
| 11 | 1366404345 | OTHER | PENNSYLVANIA | GEISINGER HEALTH PLAN |
| 12 | 0020592000 | OTHER | PENNSYLVANIA | KEYSTONE EAST GROUP # |
| 13 | 54384 | OTHER | PENNSYLVANIA | DAVIS AFFINITY |
| 14 | 0020572000 | OTHER | PENNSYLVANIA | INEPENDENCE BC/BS |
| 15 | 1366404345 | OTHER | PENNSYLVANIA | CIGNA HEALTHCARE |
| 16 | 1366404345 | OTHER | PENNSYLVANIA | UNITED HEALTHCARE |
| 17 | 29436 | OTHER | PENNSYLVANIA | SPECTERA |
| 18 | 429305 | MEDICARE PIN | PENNSYLVANIA | |
| 19 | 0020592000 | OTHER | PENNSYLVANIA | AMERIHEALTH GROUP # |
| 20 | 429305 | OTHER | PENNSYLVANIA | HIGHMARK/BLUE SHIELD |
