NPI Code Detail JSON Logo

1275143075 NPI number — AVA LOUISE KOCH OD

NPI Number: 1275143075
Health Care Provider/Practitioner: AVA LOUISE KOCH OD

Information about “1275143075” NPI (AVA LOUISE KOCH OD) exists in 1275143075 in HTML format HTML  |  1275143075 in plain Text format TXT  |  1275143075 in PDF (Portable Document Format) PDF  |  1275143075 in an XML format XML  formats.

NPI Number : 1275143075 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1275143075",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KOCH",
    "FirstName": "AVA",
    "MiddleName": "LOUISE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "OD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "44 ROOSEVELT ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GLEN HEAD",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11545-1422",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "516-236-8538",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "887 OLD COUNTRY RD STE G-KL",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RIVERHEAD",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11901-2115",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "631-727-2858",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/06/2020",
    "LastUpdateDate": "08/06/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "152W00000X",
        "TaxonomyName": "Optometrist",
        "LicenseNumber": "009217",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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