{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "DR MARIA SAMPALIS",
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"OrgName": "SAMPALIS EYECARE PC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "24 SCARALIA RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CRANSTON",
"MailingAddressStateName": "RI",
"MailingAddressPostalCode": "02921",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "401-241-9188",
"MailingAddressFaxNumber": "401-828-4240",
"FirstLinePracticeLocationAddress": "650 BALD HILL RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WARWICK",
"PracticeLocationAddressStateName": "RI",
"PracticeLocationAddressPostalCode": "02886-1863",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "401-822-2050",
"PracticeLocationAddressFaxNumber": "401-822-2050",
"EnumerationDate": "06/05/2012",
"LastUpdateDate": "05/02/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SAMPALIS",
"AuthorizedOfficialFirstName": "MARIA",
"AuthorizedOfficialMiddleName": "P",
"AuthorizedOfficialTitle": "DR",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "401-241-9188",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "MA4629",
"LicenseNumberStateCode": "MA",
"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."
}
}
}
}