NPI Code Detail JSON Logo

1205633633 NPI number — VISIONARY REALM OPTOMETRY PLLC

NPI Number: 1205633633
Health Care Provider/Practitioner: VISIONARY REALM OPTOMETRY PLLC

Information about “1205633633” NPI (VISIONARY REALM OPTOMETRY PLLC) exists in 1205633633 in HTML format HTML  |  1205633633 in plain Text format TXT  |  1205633633 in PDF (Portable Document Format) PDF  |  1205633633 in an XML format XML  formats.

NPI Number : 1205633633 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1205633633",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "VISIONARY REALM OPTOMETRY PLLC",
    "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": "1620 MIDTOWN PL",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MIDWEST CITY",
    "MailingAddressStateName": "OK",
    "MailingAddressPostalCode": "73130-6347",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "405-458-9393",
    "MailingAddressFaxNumber": "405-610-0321",
    "FirstLinePracticeLocationAddress": "1620 MIDTOWN PL",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MIDWEST CITY",
    "PracticeLocationAddressStateName": "OK",
    "PracticeLocationAddressPostalCode": "73130-6347",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "405-458-9393",
    "PracticeLocationAddressFaxNumber": "405-610-0321",
    "EnumerationDate": "02/25/2025",
    "LastUpdateDate": "07/02/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "COX",
    "AuthorizedOfficialFirstName": "ALICHIA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OPTOMETRIST",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "OD",
    "AuthorizedOfficialTelephoneNumber": "405-458-9393",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "152WC0802X",
          "TaxonomyName": "Corneal and Contact Management Optometrist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152WP0200X",
          "TaxonomyName": "Pediatric Optometrist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152WS0006X",
          "TaxonomyName": "Sports Vision Optometrist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152WV0400X",
          "TaxonomyName": "Vision Therapy Optometrist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "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."
        },
        {
          "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."
        },
        {
          "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."
        },
        {
          "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."
        },
        {
          "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."
        }
      ]
    }
  }
}
                
            

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