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 | | 4237 | 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 | W17386 | OTHER | | MEDICARE W21056 |
| 2 | 32051 | OTHER | | NHP 0026263 |
| 3 | 73083 | OTHER | | CMSP |
| 4 | MA4231 | OTHER | | EYEMED |
| 5 | 30556 | OTHER | | BMC HEALTHNET ADD 7 0S |
| 6 | W17386 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
| 7 | 5426454 | OTHER | | FH CCN |
| 8 | W16348 | OTHER | | BCBS W20072 OD NO BLUE 65 |
| 9 | 1404530 | OTHER | | UNITED HEALTH CARE |
| 10 | 3164443 | OTHER | | AETNA |
| 11 | 977297 | OTHER | | NETWORK HEALTH GRP 40403 |
| 12 | 0336441 | MEDICAID | MASSACHUSETTS | |
| 13 | 153341 | OTHER | | HARVARD PILGRIM |
| 14 | 2048274 | OTHER | | FIRST HEALTH |
| 15 | 625167 | OTHER | | CIGNA GROUP 62516 |
| 16 | 0336441 | OTHER | | MASS HEALTH GROUP 9721100 |
| 17 | U87070 | MEDICARE UPIN | | |
| 18 | 791541 | MEDICAID | MASSACHUSETTS | |
