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 | | OEG00004 | 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 | 0020591000 | OTHER | PENNSYLVANIA | KEYSTONE EAST ID |
| 2 | 01806401 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS ID |
| 3 | 01806401 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS/KHPC |
| 4 | 232211591 | OTHER | PENNSYLVANIA | BERKSHIRE HEALTH PARTNER |
| 5 | NON PAR | OTHER | PENNSYLVANIA | DAVIS VISION |
| 6 | 0020591000 | OTHER | PENNSYLVANIA | INDEPENDENCE PERSONAL CHOICE |
| 7 | 01806401 | OTHER | PENNSYLVANIA | KEYSTONE/CBC |
| 8 | 2144950 | OTHER | PENNSYLVANIA | UNITED HEALTHCARE |
| 9 | 410023367 | OTHER | PENNSYLVANIA | MEDICARE RAILROAD |
| 10 | 4356895 | OTHER | PENNSYLVANIA | AETNA |
| 11 | OEG000040 | OTHER | PENNSYLVANIA | DEVON |
| 12 | 426448 | OTHER | PENNSYLVANIA | HIGHMARK BLUE SHIELD ID |
| 13 | 426448 | OTHER | PENNSYLVANIA | HIGHMARK/CLASSIC/PPO/PPO BLUE/HMO |
| 14 | OEG000040 | OTHER | PENNSYLVANIA | HUMANA |
| 15 | 01806401 | OTHER | PENNSYLVANIA | KEYSTONE/SENIOR BLUE ID |
| 16 | 01806401 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS/SB/SB PPO/HMO |
| 17 | PA05925 | OTHER | PENNSYLVANIA | VBA/VISION BENEFITS OF AMERICA |
| 18 | OEG000040 | OTHER | PENNSYLVANIA | CORESOURCE |
| 19 | 0020591000 | OTHER | PENNSYLVANIA | INDEPENDENCE BC/BS |
| 20 | 2206957 | OTHER | PENNSYLVANIA | SECURE HORIZON |
| 21 | 4356895 | OTHER | PENNSYLVANIA | AETNA/HMO |
| 22 | NON PAR | OTHER | PENNSYLVANIA | NVA |
| 23 | 0020591000 | OTHER | PENNSYLVANIA | AMERIHEALTH PROVIDER ID |
| 24 | 20861 | OTHER | PENNSYLVANIA | GEISINGER |
| 25 | 385702 | OTHER | PENNSYLVANIA | HEALTHAMERICA/HEALTHASSURANCE |
| 26 | 4356895 | OTHER | PENNSYLVANIA | AETNA TRADITIONAL/PPO |
| 27 | 54384002 | OTHER | PENNSYLVANIA | DAVIS AFFINITY |
| 28 | 426448HD1 | MEDICARE PIN | PENNSYLVANIA | |
| 29 | 29435/29436 | OTHER | PENNSYLVANIA | SPECTERA |
| 30 | 4589194 | OTHER | PENNSYLVANIA | CIGNA |
| 31 | OEG000040 | OTHER | PENNSYLVANIA | LOOMIS |
| 32 | 01806401 | OTHER | PENNSYLVANIA | CAPITAL BLUE CROSS/POS/PPO/TRADITIONAL |
| 33 | 1508828666 | OTHER | PENNSYLVANIA | VSP/VISION SERVICE PLAN |
| 34 | T30362 | MEDICARE UPIN | PENNSYLVANIA | |
| 35 | 0966540001 | MEDICARE NSC | PENNSYLVANIA | |
