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 | | S380TA051 | ALABAMA | 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 | 7450211 | OTHER | ALABAMA | AETNA |
| 2 | 0139856 | OTHER | ALABAMA | BCBS OF TN |
| 3 | 51059448 | OTHER | ALABAMA | BCBS OF AL |
| 4 | 0605110001 | MEDICARE NSC | ALABAMA | |
| 5 | T68961 | OTHER | ALABAMA | HEALTHSPRING OF ALABAMA I |
| 6 | 2210144 | OTHER | ALABAMA | UNITED HEALTHCARE INS CO |
| 7 | ========= | OTHER | ALABAMA | BCBS OF CA |
| 8 | =========0002 | OTHER | ALABAMA | CIGNA HEALTHCARE |
| 9 | ========= | OTHER | ALABAMA | NATL ASSOC OF LTR CARRIER |
| 10 | T68961 | MEDICARE UPIN | | |
| 11 | ========= | OTHER | ALABAMA | TRICARE |
| 12 | ========= | OTHER | ALABAMA | MUTUAL OF OMAHA COMPANIES |
| 13 | 000059448 | MEDICARE ID-TYPE UNSPECIFIED | ALABAMA | |
| 14 | 000059448 | MEDICAID | ALABAMA | |
| 15 | C000059448 | OTHER | ALABAMA | UNITED AMERICAN INS CO |
| 16 | 0605110001 | OTHER | ALABAMA | PALMETTO GBA |
