{
"Npi": {
"NPI": "1114015393",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BINGHAMPTON OPTICAL INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "MOHAWK ACRES SHOPPING CENTER",
"SecondLineMailingAddress": "BLACK RIVER BLVD",
"MailingAddressCityName": "ROME",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "13440",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "315-339-3500",
"MailingAddressFaxNumber": "315-339-3500",
"FirstLinePracticeLocationAddress": "MOHAWK ACRES SHOPPING CENTER",
"SecondLinePracticeLocationAddress": "BLACK RIVER BLVD",
"PracticeLocationAddressCityName": "ROME",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "13440",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "315-339-3500",
"PracticeLocationAddressFaxNumber": "315-339-3500",
"EnumerationDate": "10/11/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WHITING",
"AuthorizedOfficialFirstName": "KEVIN",
"AuthorizedOfficialMiddleName": "P",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "607-723-8357",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "0055661",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}