{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
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"LastName": null,
"FirstName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "418 AUTO CENTER DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CLAREMONT",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91711-5458",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-621-5400",
"MailingAddressFaxNumber": "909-621-5411",
"FirstLinePracticeLocationAddress": "418 AUTO CENTER DR",
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"PracticeLocationAddressCityName": "CLAREMONT",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "909-621-5400",
"PracticeLocationAddressFaxNumber": "909-621-5411",
"EnumerationDate": "04/03/2014",
"LastUpdateDate": "04/03/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BEBAWY",
"AuthorizedOfficialFirstName": "MAGDY",
"AuthorizedOfficialMiddleName": "AZIZ KEROLLOS",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O.D",
"AuthorizedOfficialTelephoneNumber": "909-235-1998",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "14579TPA",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}