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 | OPT 7311 TPL | CALIFORNIA | No |
| 2 | 152WL0500X | Optometrist | Low Vision Rehabilitation | OPT 7311 TPL | CALIFORNIA | No |
| 3 | 152WP0200X | Optometrist | Pediatrics | OPT 7311 TPL | CALIFORNIA | No |
| 4 | 152WS0006X | Optometrist | Sports Vision | OPT 7311 TPL | CALIFORNIA | No |
| 5 | 152WV0400X | Optometrist | Vision Therapy | OPT 7311 TPL | CALIFORNIA | No |
| 6 | 152WX0102X | Optometrist | Occupational Vision | OPT 7311 TPL | CALIFORNIA | No |
| 7 | 152W00000X | Optometrist | | OPT 7311 TPL | CALIFORNIA | 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 | T10509 | MEDICARE UPIN | CALIFORNIA | |
| 2 | SD0073111 | MEDICARE PIN | CALIFORNIA | |
| 3 | SD0073110 | MEDICAID | CALIFORNIA | |