{
"Npi": {
"NPI": "1295804458",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FERNANDO F. LOPEZ, M.D., S.C.",
"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": "143 SOUTH LINCOLN AVENUE, SUITE J",
"SecondLineMailingAddress": "AURORA MEDICAL PARK",
"MailingAddressCityName": "AURORA",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60505-4290",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "630-859-2680",
"MailingAddressFaxNumber": "810-454-2423",
"FirstLinePracticeLocationAddress": "143 SOUTH LINCOLN AVENUE, SUITE J",
"SecondLinePracticeLocationAddress": "AURORA MEDICAL PARK",
"PracticeLocationAddressCityName": "AURORA",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60505-4290",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "630-859-2680",
"PracticeLocationAddressFaxNumber": "810-454-2423",
"EnumerationDate": "11/06/2006",
"LastUpdateDate": "11/20/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LOPEZ",
"AuthorizedOfficialFirstName": "FERNANDO",
"AuthorizedOfficialMiddleName": "F",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "630-859-2680",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207W00000X",
"TaxonomyName": "Ophthalmology Physician",
"LicenseNumber": "036-104977",
"LicenseNumberStateCode": "IL",
"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."
}
}
}
}