{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "TONY C LIEU OPTOMETRIC PROFESSIONAL CORPORATION",
"LastName": null,
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"NamePrefix": null,
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"Credential": null,
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"OtherOrgNameTypeCode": null,
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"FirstLineMailingAddress": "3833 BEDFORD CANYON RD",
"SecondLineMailingAddress": "STE #C-101",
"MailingAddressCityName": "CORONA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92883-0788",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "951-898-6979",
"MailingAddressFaxNumber": "888-818-4787",
"FirstLinePracticeLocationAddress": "3833 BEDFORD CANYON RD",
"SecondLinePracticeLocationAddress": "STE #C-101",
"PracticeLocationAddressCityName": "CORONA",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "951-898-6979",
"PracticeLocationAddressFaxNumber": "888-818-4787",
"EnumerationDate": "10/25/2006",
"LastUpdateDate": "03/20/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LIEU",
"AuthorizedOfficialFirstName": "TONY",
"AuthorizedOfficialMiddleName": "C",
"AuthorizedOfficialTitle": "OPTOMETRIST",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "951-898-6979",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "OPT11916",
"LicenseNumberStateCode": "CA",
"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."
}
}
}
}