{
"Npi": {
"NPI": "1205274255",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "OPTIMAGE HEALTH 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": "930 MISSION ST",
"SecondLineMailingAddress": "SUITE 5",
"MailingAddressCityName": "SANTA CRUZ",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95060-3559",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "831-421-0197",
"MailingAddressFaxNumber": "888-449-2472",
"FirstLinePracticeLocationAddress": "930 MISSION ST",
"SecondLinePracticeLocationAddress": "SUITE 5",
"PracticeLocationAddressCityName": "SANTA CRUZ",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95060-3559",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "831-421-0197",
"PracticeLocationAddressFaxNumber": "888-449-2472",
"EnumerationDate": "06/12/2013",
"LastUpdateDate": "12/27/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MOTYKA",
"AuthorizedOfficialFirstName": "DEBORAH",
"AuthorizedOfficialMiddleName": "DAWN",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "831-421-0197",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "G63571",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}