{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ULTRA VISION OPTICAL CENTER INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "812 HICKSVILLE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "N MASSAPEQUA",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11758-1262",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-796-2020",
"MailingAddressFaxNumber": "516-796-3818",
"FirstLinePracticeLocationAddress": "812 HICKSVILLE RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "N MASSAPEQUA",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "516-796-2020",
"PracticeLocationAddressFaxNumber": "516-796-3818",
"EnumerationDate": "02/20/2007",
"LastUpdateDate": "06/15/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BART",
"AuthorizedOfficialFirstName": "JASON",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OPTOMETRIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "516-796-2020",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "305R00000X",
"TaxonomyName": "Preferred Provider Organization",
"LicenseNumber": "TUV006342",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "152W00000X",
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"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."
}
}
}
}