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 | 332B00000X | Durable Medical Equipment & Medical Supplies | | | | 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 | 5090961 | OTHER | CONNECTICUT | CONNECTICUT GENERAL LIFE INSURANCE CO |
| 2 | 0906860002 | MEDICARE NSC | TEXAS | |
| 3 | 925101 | OTHER | TEXAS | BLOCK VISION OF TEXAS |
| 4 | 0906860002 | OTHER | SOUTH CAROLINA | TRICARE HUMANA MILITARY HEALTHCARE SERVICES |
| 5 | 0906860002 | OTHER | TEXAS | TRS ACTIVCARE |
| 6 | 908788 | OTHER | TEXAS | BLOCK VISION OF TEXAS INC |
| 7 | 0906860002 | OTHER | NEBRASKA | AMERITAS LIFE INSURANCE CORP |
| 8 | 4007229 | OTHER | TENNESSEE | BLUE CROSS BLUE SHIELD OF TENNESSEE |
| 9 | 504262 | OTHER | TEXAS | BLUE CROSS BLUE SHIELD OF TEXAS |
| 10 | 0005524399 | OTHER | KENTUCKY | AETNA |
| 11 | 086517201 | MEDICAID | TEXAS | |
| 12 | 32603 | OTHER | TEXAS | OPTICARE MANAGED VISION |
| 13 | 0906860002 | OTHER | CALIFORNIA | SUPERIOR VISION SERVICES INC |
| 14 | OP1740 | OTHER | OHIO | EYEMED VISION CARE |
| 15 | 80112 | OTHER | ARIZONA | AVESIS |
