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 | | 1610 | MINNESOTA | 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 | OD327JE | OTHER | | FIRST FIRST PLAN PIN |
| 2 | 411260738 | OTHER | | BCWP BCBS OF PENN PIN |
| 3 | 524223100 | OTHER | | MNMA MN MED ASSIST PIN |
| 4 | 2200980 | OTHER | | MDMA1 MEDICA PIN |
| 5 | 411260738 | OTHER | | PABS CLARITY VISION PIN |
| 6 | OD327JE | OTHER | | BCMAD BCBS PIN |
| 7 | 419000858 | MEDICARE PIN | | |
| 8 | OD327JE | OTHER | | FIRSD FIRST PLAN DISP PIN |
| 9 | OD327JE | OTHER | | COM COMP CARE PIN |
| 10 | OD327JE | OTHER | | ANTHEM BCBS PIN |
| 11 | 0150730001 | MEDICARE NSC | MINNESOTA | |
| 12 | 2200981 | OTHER | | MDMA2 MEDICA PIN |
| 13 | OD327JE | OTHER | | BCMN BCBS PIN |
| 14 | T65653 | MEDICARE UPIN | | |
| 15 | 01020509 | OTHER | | PRE00 UNITED HEALTH PIN |
| 16 | 2100694 | OTHER | | MDMA3 MEDICA PIN |
| 17 | 2200980 | OTHER | | MCCS1 MEDICA PIN |
| 18 | 410000645 | MEDICARE PIN | | |
| 19 | OD327JE | OTHER | | BCMA BCBS PIN |
| 20 | 01020509 | OTHER | | BOIS PREFERRED ONE PIN |
| 21 | 0150730001 | OTHER | | ADMINISTAR FEDERAL(DMERC), INC. |
