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 | OPT 7532 TPA | CALIFORNIA | No |
| 2 | 152WL0500X | Optometrist | Low Vision Rehabilitation | OPT 7532 TPA | CALIFORNIA | No |
| 3 | 152WP0200X | Optometrist | Pediatrics | OPT 7532 TPA | CALIFORNIA | No |
| 4 | 152WS0006X | Optometrist | Sports Vision | OPT 7532 TPA | CALIFORNIA | No |
| 5 | 152WV0400X | Optometrist | Vision Therapy | OPT 7532 TPA | CALIFORNIA | No |
| 6 | 152WX0102X | Optometrist | Occupational Vision | OPT 7532 TPA | CALIFORNIA | No |
| 7 | 152W00000X | Optometrist | | OPT 7532 TPA | CALIFORNIA | 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 | 770194563 | MEDICARE UPIN | CALIFORNIA | |
| 2 | EK0062 | MEDICARE PIN | CALIFORNIA | |
| 3 | 1396787214 | OTHER | CALIFORNIA | GROUP NPI |
| 4 | 204977941 | MEDICARE UPIN | CALIFORNIA | |
