{
"Npi": {
"NPI": "1043407927",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WALSH OPTOMETRY, P.A.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "P.O. BOX 80214",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RALEIGH",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27623-0214",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "919-792-2999",
"MailingAddressFaxNumber": "919-554-1406",
"FirstLinePracticeLocationAddress": "7330 OLD WAKE FOREST RD.",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RALEIGH",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27616-3047",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "919-792-2999",
"PracticeLocationAddressFaxNumber": "919-554-1406",
"EnumerationDate": "09/25/2007",
"LastUpdateDate": "11/04/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WALSH",
"AuthorizedOfficialFirstName": "EILEEN",
"AuthorizedOfficialMiddleName": "MARIE",
"AuthorizedOfficialTitle": "OPTOMETRIST/PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "919-844-0938",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "1630",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}