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 | | 3027/T449 | OHIO | 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 | 0401354 | MEDICARE PIN | | |
| 2 | 298423149006 | OTHER | OHIO | MEDICAL MUTUAL OF OHIO |
| 3 | P00305907 | MEDICARE PIN | OHIO | |
| 4 | 04231 | OTHER | OHIO | PARAMOUNT HEALTH CARE |
| 5 | 9359922 | MEDICARE PIN | OHIO | |
| 6 | 300709331004 | OTHER | OHIO | MEDICAL MUTUAL OF OHIO |
| 7 | DE6416 | MEDICARE ID-TYPE UNSPECIFIED | OHIO | RAILROAD MEDICARE GROUP |
| 8 | V08892 | MEDICARE UPIN | OHIO | |
| 9 | 000000510602 | OTHER | OHIO | ANTHEM BCBS |
| 10 | 000000519919 | OTHER | OHIO | ANTHEM BCBS |
| 11 | 2628704 | MEDICAID | OHIO | |
| 12 | 2284611 | MEDICAID | OHIO | |
| 13 | 0257181 | MEDICAID | OHIO | |
| 14 | 0418730001 | MEDICARE NSC | OHIO | |
| 15 | 4180343 | MEDICARE PIN | OHIO | |
| 16 | 6171920001 | MEDICARE NSC | OHIO | |
| 17 | 02487 | OTHER | OHIO | PARAMOUNT HEALTH CARE |
| 18 | T78479 | MEDICARE UPIN | OHIO | |
