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 | 27OA00506600 | NEW JERSEY | No |
| 2 | 152WL0500X | Optometrist | Low Vision Rehabilitation | 27OA00506600 | NEW JERSEY | No |
| 3 | 152WP0200X | Optometrist | Pediatrics | 27OA00506600 | NEW JERSEY | No |
| 4 | 152WV0400X | Optometrist | Vision Therapy | 27OA00506600 | NEW JERSEY | No |
| 5 | 152W00000X | Optometrist | | 27OA00506600 | NEW JERSEY | 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 | ========= | OTHER | NEW JERSEY | CONSUMER HEALTH NETWORK |
| 2 | ========= | OTHER | NEW JERSEY | DEVON |
| 3 | ========= | OTHER | NEW JERSEY | QUALCARE HMO AND PPO |
| 4 | 067385 | MEDICARE ID-TYPE UNSPECIFIED | NEW JERSEY | GROUP # |
| 5 | ========= | OTHER | NEW JERSEY | COMMISSION FOR THE BLIND |
| 6 | ========= | OTHER | NEW JERSEY | HORIZON BCBS |
| 7 | 4810910001 | MEDICARE NSC | NEW JERSEY | |
| 8 | ========= | OTHER | NEW JERSEY | BEECH STREET |
| 9 | ========= | OTHER | NEW JERSEY | VISION SERVICE PLAN |
