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 | | 358 | NORTH DAKOTA | 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 | N8807 | MEDICARE PIN | NORTH DAKOTA | |
| 2 | 140622 | OTHER | NORTH DAKOTA | UCARE MINN |
| 3 | 0677790001 | OTHER | NORTH DAKOTA | CIGNA |
| 4 | 91398 | OTHER | NORTH DAKOTA | EYES FOR NEEDY |
| 5 | 93094CA | OTHER | NORTH DAKOTA | BLUE CROSS MINNESOTA |
| 6 | CLA800358 | OTHER | NORTH DAKOTA | VISION SERVICES INC |
| 7 | 60162 | MEDICAID | NORTH DAKOTA | |
| 8 | 979611041243 | OTHER | NORTH DAKOTA | PREFERRED ONE |
| 9 | T66858 | MEDICARE UPIN | NORTH DAKOTA | |
