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 | | 3338 | 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 | 042472266 | OTHER | | HEALTHCARE VALUE MANAGEME |
| 2 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 3 | 416058 | MEDICARE ID-TYPE UNSPECIFIED | | |
| 4 | 410045410 | MEDICARE ID-TYPE UNSPECIFIED | | RAILROAD MEDICARE |
| 5 | 042472266 | OTHER | | TRICARE CHAMPUS |
| 6 | 2213091 | OTHER | | FIRST HEALTH |
| 7 | 416058 | MEDICARE ID-TYPE UNSPECIFIED | | MEDICARE B |
| 8 | 4590569 | OTHER | | AETNA US HEALTHCARE |
| 9 | 042472266 | OTHER | | ONE HEALTH PLAN |
| 10 | 042472266 | OTHER | | THREE RIVERS |
| 11 | T59435 | MEDICARE UPIN | | |
| 12 | 61208 | OTHER | | FALLON COMMUNITY HEALTH P |
| 13 | W15740 | OTHER | | BLUE CARE ELECT |
| 14 | AA2836 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 15 | 787403 | OTHER | | MVP HEALTH CARE |
| 16 | 2649494 | OTHER | | CIGNA PAL ID |
| 17 | 60436 | OTHER | | CHILDRENS MEDICAL SECURIT |
