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 | | 3239 | 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 | W15678 | OTHER | | BLUE SHIELD INDEMNITY |
| 2 | 0353361 | MEDICAID | MASSACHUSETTS | |
| 3 | 042472266 | OTHER | | PRIVATE HEALTHCARE SYSTEM |
| 4 | 10267601 | OTHER | | CIGNA HEALTH PLAN |
| 5 | 35481175 | OTHER | | CIGNA HEALTHSOURCE |
| 6 | W15678 | OTHER | | BLUE CARE ELECT |
| 7 | 042472266 | OTHER | | TRICARE CHAMPUS |
| 8 | 48391 | OTHER | | FALLON COMMUNITY HEALTH |
| 9 | 786732 | OTHER | | MVP HEALTH CARE |
| 10 | 38080 | OTHER | | CHILDRENS MEDICAL SECURIT |
| 11 | AA2842 | OTHER | | HARVARD PILGRIM HEALTHCAR |
| 12 | 5882695 | OTHER | | AETNA US HEALTHCARE |
| 13 | 042472266 | OTHER | | THREE RIVERS |
| 14 | 2213197 | OTHER | | FIRST HEALTH |
| 15 | W15678 | OTHER | | BLUE SHIELD HMO BLUE |
| 16 | 2009740002 | OTHER | | CIGNA PAL ID |
