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 | 152WC0802X | Optometrist | Corneal and Contact Management | TUV005837-1 | NEW YORK | No |
| 2 | 152WC0802X | Optometrist | Corneal and Contact Management | VUT 005837 | NEW YORK | No |
| 3 | 152WL0500X | Optometrist | Low Vision Rehabilitation | VUT 005837 | NEW YORK | No |
| 4 | 152WP0200X | Optometrist | Pediatrics | VUT 005837 | NEW YORK | No |
| 5 | 152WS0006X | Optometrist | Sports Vision | VUT 005837 | NEW YORK | No |
| 6 | 152WV0400X | Optometrist | Vision Therapy | VUT 005837 | NEW YORK | No |
| 7 | 152WX0102X | Optometrist | Occupational Vision | VUT005837 | NEW YORK | No |
| 8 | 152W00000X | Optometrist | | VUT 005837 | NEW YORK | 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 | U69619 | MEDICARE UPIN | NEW YORK | |
| 2 | C38221 | MEDICARE PIN | NEW YORK | |
| 3 | 01956312 | MEDICAID | NEW YORK | |
