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 | 207W00000X | Ophthalmology | | 17772 | SOUTH CAROLINA | 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 | 6282 | MEDICARE ID-TYPE UNSPECIFIED | SOUTH CAROLINA | HAMPTON OFFICE |
| 2 | T12108 | MEDICAID | SOUTH CAROLINA | |
| 3 | 180024498 | OTHER | SOUTH CAROLINA | RAIL ROAD MEDICARE # |
| 4 | GP2689 | MEDICAID | SOUTH CAROLINA | |
| 5 | 6280 | MEDICARE ID-TYPE UNSPECIFIED | SOUTH CAROLINA | BEAUFORT OFFICE |
| 6 | F81047 | MEDICARE UPIN | SOUTH CAROLINA | |
| 7 | CC2519 | OTHER | SOUTH CAROLINA | RAIL ROAD MEDICARE GP# |
| 8 | GP1358 | MEDICAID | SOUTH CAROLINA | |