{
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"EIN": null,
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"OrgName": "HOPTICAL",
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"Credential": null,
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"OtherLastName": null,
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"FirstLineMailingAddress": "423 CALLE SAN JULIAN",
"SecondLineMailingAddress": "URB. SAGRADO CORAZON",
"MailingAddressCityName": "SAN JUAN",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00926-4243",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-637-0834",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "CARR. 172, URB. TURABO GARDENS",
"SecondLinePracticeLocationAddress": "HOSPITAL MENONITA CAGUAS, PRIMER PISO",
"PracticeLocationAddressCityName": "CAGUAS",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00725",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-637-0834",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/07/2013",
"LastUpdateDate": "03/07/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WILEY",
"AuthorizedOfficialFirstName": "GRACE",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "OPTOMETRIST",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "787-637-0834",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "464",
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},
{
"TaxonomyCode": "152W00000X",
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}
]
},
"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."
}
}
}
}