{
"Npi": {
"NPI": "1265567812",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BRYAN MATTISON AND ROJEK PTRS",
"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": "15 W MAIN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CAMBRIDGE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "12816-1152",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "518-677-5422",
"MailingAddressFaxNumber": "518-677-5134",
"FirstLinePracticeLocationAddress": "15 W MAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CAMBRIDGE",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "12816-1152",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "518-677-5422",
"PracticeLocationAddressFaxNumber": "518-677-5134",
"EnumerationDate": "02/23/2007",
"LastUpdateDate": "02/18/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": "01/28/2025",
"NPIReactivationDate": "02/18/2025",
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MATTISON",
"AuthorizedOfficialFirstName": "GERALD",
"AuthorizedOfficialMiddleName": "G",
"AuthorizedOfficialTitle": "PARTNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "518-677-5422",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "VUT004160-1",
"LicenseNumberStateCode": "NY",
"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."
}
}
}
}