{
"Npi": {
"NPI": "1306297650",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "OCULUS HEALTH MANAGEMENT",
"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": "1808 JIM REDMAN PKWY",
"SecondLineMailingAddress": "#117",
"MailingAddressCityName": "PLANT CITY",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33563-6914",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "813-752-5838",
"MailingAddressFaxNumber": "813-754-4432",
"FirstLinePracticeLocationAddress": "2602 JIM REDMAN PKWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PLANT CITY",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33566-9460",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "863-608-5330",
"PracticeLocationAddressFaxNumber": "813-754-4432",
"EnumerationDate": "06/28/2016",
"LastUpdateDate": "06/28/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRUCE",
"AuthorizedOfficialFirstName": "ROY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OPTOMETRIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "863-608-5330",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "OPC1905",
"LicenseNumberStateCode": "FL",
"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."
}
}
}
}