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 | 12450 | CALIFORNIA | No |
| 2 | 152WC0802X | Optometrist | Corneal and Contact Management | OPC 4148 | FLORIDA | No |
| 3 | 152WC0802X | Optometrist | Corneal and Contact Management | 1346 | ARIZONA | No |
| 4 | 152WC0802X | Optometrist | Corneal and Contact Management | TUV006648-1 | NEW YORK | 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 | 1881673184 | OTHER | | BRICKLAYERS |
| 2 | 1881673184 | OTHER | | VSP |
| 3 | 1881673184 | OTHER | | ELDER PLAN |
| 4 | 214775 | OTHER | NEW YORK | EYEMED |
| 5 | P3814314 | OTHER | | OXFORD |
| 6 | 1881673184 | OTHER | | MULTIPLAN |
| 7 | 39079 | OTHER | | MES VISION |
| 8 | 57117 | OTHER | | CSEA |
| 9 | 936231 | OTHER | | AMERIGROUP |
| 10 | IE0069 | OTHER | | EYE QUEST VISION |
| 11 | 0135527 | OTHER | | EMBLEM HEALTH |
| 12 | 330816 | OTHER | | NVA |
| 13 | 57117 | OTHER | | NEIGHBOORHOOD |
| 14 | 936231 | OTHER | | BLOCKVISION |
| 15 | C399G1 | OTHER | | MEDICARE |
| 16 | C399G2 | OTHER | | BLUE CROSS BLUE SHIELD |
| 17 | IE0069 | OTHER | | DORAL VISION |
| 18 | 00002813319-01 | OTHER | | UNITED HEALTH CARE |
| 19 | 02896642 | OTHER | NEW YORK | MEDICAID |
| 20 | 1602400 | OTHER | | FIRST HEALTH |
| 21 | 1881673184 | OTHER | | ROOFERS WATERPROOFERS |
| 22 | 47175 | OTHER | | SPECTERA |
| 23 | 47734 | OTHER | | AVESIS |
| 24 | 7457515 | OTHER | | AETNA |
| 25 | V05657 | MEDICARE UPIN | NEW YORK | |
| 26 | 2585193 | OTHER | | GREAT WEST |
| 27 | 383511P | OTHER | | HIP |
| 28 | 57117 | OTHER | | HEALTH FIRST |
| 29 | 000551510101 | OTHER | | HEALTH PLUS |
| 30 | 1881673184 | OTHER | | UNICARE |
| 31 | 1881673184 | OTHER | | SUPERIOR VISION |
| 32 | 2585193 | OTHER | | CIGNA |
| 33 | 57117 | OTHER | | DAVIS VISION |
| 34 | 6C1614 | OTHER | | HEALTH NET |
| 35 | 108 | OTHER | | VISION SCREENING |
| 36 | 1881673184 | OTHER | | PHCS |
| 37 | 47175 | OTHER | | OPTUM HEALTH |
| 38 | 57117 | OTHER | | FIDELIS |
| 39 | 1602400 | OTHER | | COVENTRY |
| 40 | 57117 | OTHER | | NY PRESBYTERIAN |
| 41 | 953N | OTHER | | NATIONAL OPTICAL SERVICE |
| 42 | P0T00648 | OTHER | | METRO PLUS |
