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 | | TPA 27TO00029600 | NEW JERSEY | No |
| 2 | 152W00000X | Optometrist | | 27OM00047500 | NEW JERSEY | No |
| 3 | 152W00000X | Optometrist | | 27OA00368600 | 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 | 334259 | OTHER | NEW JERSEY | GREAT-WEST HEALTH ID |
| 2 | P479247 | OTHER | NEW JERSEY | OXFORD HEALTH PLAN ID |
| 3 | 6500580 | OTHER | NEW JERSEY | GHI PROVIDER ID |
| 4 | U26863 | MEDICARE UPIN | NEW JERSEY | |
| 5 | 410006990 | OTHER | NEW JERSEY | PALMETTO GBA-RAILROAD MEDICARE |
| 6 | 222209011 | OTHER | NEW JERSEY | HORIZON BLUE CROSS & BLUE SHIELD OF NJ |
| 7 | 545317 | OTHER | NEW JERSEY | AETNA U.S. HEATHCARE ID |
| 8 | 521321 | MEDICARE PIN | NEW JERSEY | |
| 9 | C7E921 | OTHER | NEW JERSEY | EMPIRE BC ID |
| 10 | F09898 | OTHER | NEW JERSEY | HEALTH NET ID |
