{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "AL VINCENT D. ROMERO, O.D. INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
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"NameSuffix": null,
"Credential": null,
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"FirstLineMailingAddress": "6593 ACEY ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CORONA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92880-3476",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-753-7126",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "9496 MAGNOLIA AVE STE 102",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RIVERSIDE",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92503-3733",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "951-687-5312",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/27/2014",
"LastUpdateDate": "06/27/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROMERO",
"AuthorizedOfficialFirstName": "AL VINCENT",
"AuthorizedOfficialMiddleName": "D",
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "909-753-7126",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "12695T",
"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."
}
}
}
}