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 | 27OA00506600 | NEW JERSEY | No |
| 2 | 152WP0200X | Optometrist | Pediatrics | 27OA00506600 | NEW JERSEY | No |
| 3 | 152WS0006X | Optometrist | Sports Vision | 27OA00506600 | NEW JERSEY | No |
| 4 | 152WV0400X | Optometrist | Vision Therapy | 27OA00506600 | NEW JERSEY | No |
| 5 | 152W00000X | Optometrist | | 27OA00506600 | NEW JERSEY | 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 | 32336 | OTHER | NEW JERSEY | AETNA |
| 2 | 223342537 | OTHER | NEW JERSEY | DEVON |
| 3 | 223342537 | OTHER | NEW JERSEY | CONSUMER HEALTH NETWORK |
| 4 | 223342537 | OTHER | NEW JERSEY | VBA |
| 5 | U18438 | MEDICARE UPIN | NEW JERSEY | |
| 6 | 110373 | OTHER | NEW JERSEY | EYEMED |
| 7 | 676054RG4 | MEDICARE PIN | NEW JERSEY | |
| 8 | 12013 | OTHER | NEW JERSEY | COLE MANAGED CARE |
| 9 | 223342537 | OTHER | NEW JERSEY | HORIZON BCBS |
| 10 | 223342537 | OTHER | NEW JERSEY | VISION SERVICE PLAN |
| 11 | 067385 | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | GROUP# |
| 12 | 223342537 | OTHER | NEW JERSEY | BEECH STREET |
| 13 | HUS014 | OTHER | NEW JERSEY | OXFORD |
| 14 | 4810910001 | MEDICARE NSC | NEW JERSEY | |
