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 | | 3337 | MASSACHUSETTS | 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 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 2 | 042472266 | OTHER | | TRICARE CHAMPUS |
| 3 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 4 | 2213103 | OTHER | | FIRST HEALTH |
| 5 | 787397 | OTHER | | MVP HEALTH CARE |
| 6 | W16360 | OTHER | | BLUE CARE ELECT |
| 7 | 042472266 | OTHER | | HEALTHCARE VALUE MANAGEME |
| 8 | 61209 | OTHER | | FALLON COMMUNITY HEALTH P |
| 9 | W16360 | OTHER | | BLUE SHIELD HMO BLUE |
| 10 | 1692125 | OTHER | | CIGNA PAL ID |
| 11 | 410045266 | OTHER | | RAILROAD MEDICARE |
| 12 | 042472266 | OTHER | | THREE RIVERS |
| 13 | W17040 | OTHER | | MEDICARE B |
| 14 | 0335096 | OTHER | | MEDICAID WELFARE |
| 15 | 49575 | OTHER | | CHILDRENS MEDICAL SECURIT |
| 16 | AA2356 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 17 | W16360 | OTHER | | BLUE SHIELD INDEMNITY |
| 18 | 7985576 | OTHER | | AETNA US HEALTHCARE |
