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 | | 535 | 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 | 9202869-535.1 | OTHER | | DAKOTA CARE SIOUX FALLS |
| 2 | 5C469HO | OTHER | MINNESOTA | BCBS SIOUX FALLS |
| 3 | 2202147 | OTHER | | MEDICA BRANDON |
| 4 | 410031181 | OTHER | | RAILROAD MCR |
| 5 | S6148 | MEDICARE ID-TYPE UNSPECIFIED | SOUTH DAKOTA | BRANDON |
| 6 | 5C470HO | OTHER | MINNESOTA | BCBS BRANDON |
| 7 | 242530 | OTHER | | MIDLANDS CHOICE |
| 8 | U46041 | MEDICARE UPIN | | |
| 9 | 2202146 | OTHER | | MEDICA SIOUX FALLS |
| 10 | S4506 | MEDICARE ID-TYPE UNSPECIFIED | SOUTH DAKOTA | SIOUX FALLS |
| 11 | 9201702 | MEDICAID | SOUTH DAKOTA | |
| 12 | 4998511 | OTHER | SOUTH DAKOTA | BCBS BRANDON |
| 13 | 9201700 | MEDICAID | SOUTH DAKOTA | |
| 14 | 0004506 | OTHER | SOUTH DAKOTA | BCBS SIOUX FALLS |
| 15 | 20722 | OTHER | | SIOUX VALLEY HLTH PLN |
