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 | | OP3840 | 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 | 152099 | OTHER | MASSACHUSETTS | HARVARD PILGRIM |
| 2 | 392767001 | OTHER | MASSACHUSETTS | HEALTH NOW NY INS MEDICAR |
| 3 | 3927670001 | MEDICARE NSC | MASSACHUSETTS | |
| 4 | W20277 | OTHER | MASSACHUSETTS | BLUE CROSS BLUE SHIELD OF |
| 5 | 153545731 | OTHER | MASSACHUSETTS | TRICARE |
| 6 | 76434 | OTHER | RHODE ISLAND | HEALTHMATE |
| 7 | 0392375 | MEDICAID | MASSACHUSETTS | |
| 8 | 814302 | OTHER | MASSACHUSETTS | AETNA |
| 9 | W15979 | MEDICARE ID-TYPE UNSPECIFIED | MASSACHUSETTS | |
| 10 | 1984094001 | OTHER | MASSACHUSETTS | CIGNA |
| 11 | 153545731 | OTHER | MASSACHUSETTS | VISION SERVICE PLAN |
| 12 | MA3840 | OTHER | MASSACHUSETTS | EYE MED VISION |
| 13 | 2200344 | OTHER | MASSACHUSETTS | UNITED HEALTHCARE |
| 14 | 22420 | OTHER | MASSACHUSETTS | CVC MANAGEMENT |
| 15 | 34141 | OTHER | MASSACHUSETTS | DAVIS VISION |
| 16 | 409293 | OTHER | RHODE ISLAND | BLUECHIP OF RI |
| 17 | 135655 | OTHER | MASSACHUSETTS | METLIFE |
