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 | 152WC0802X | Optometrist | Corneal and Contact Management | 578 | SOUTH 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 | 11321 | OTHER | SOUTH DAKOTA | AVERA HEALTH |
| 2 | 9200863 | MEDICAID | SOUTH DAKOTA | |
| 3 | 9219420 | OTHER | SOUTH DAKOTA | DAKOTACARE GROUP |
| 4 | 5185550001 | MEDICARE NSC | SOUTH DAKOTA | |
| 5 | 2100851 | OTHER | SOUTH DAKOTA | MEDICA UNITED HEALTHCARE |
| 6 | 32866 | OTHER | SOUTH DAKOTA | SANFORD HEALTH GROUP |
| 7 | OP2175 | OTHER | SOUTH DAKOTA | EYEMED |
| 8 | U85806 | MEDICARE UPIN | SOUTH DAKOTA | |
| 9 | ========= | OTHER | SOUTH DAKOTA | TRICARE TRIWEST |
| 10 | 41775 | MEDICARE PIN | SOUTH DAKOTA | |
| 11 | 238521 | OTHER | SOUTH DAKOTA | MIDLANDS CHOICE, AETNA, CIGNA |
| 12 | 399493 | OTHER | | COVENTRY HEALTH CARE OF IOWA |
| 13 | 4995791 | OTHER | SOUTH DAKOTA | BLUE SHIELD GROUP |
| 14 | 6056244291 | OTHER | SOUTH DAKOTA | VSP |
| 15 | DU3212 | MEDICARE PIN | SOUTH DAKOTA | |
| 16 | 41823 | MEDICARE PIN | SOUTH DAKOTA | |
