{
"Npi": {
"NPI": "1497039630",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ISEE OPTOMETRY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "648 BASALT DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "VALLEJO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "94589-2100",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "510-790-4910",
"MailingAddressFaxNumber": "510-796-4777",
"FirstLinePracticeLocationAddress": "35149 NEWARK BLVD",
"SecondLinePracticeLocationAddress": "STE C",
"PracticeLocationAddressCityName": "NEWARK",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94560-1209",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "510-790-4910",
"PracticeLocationAddressFaxNumber": "510-796-4777",
"EnumerationDate": "10/06/2011",
"LastUpdateDate": "10/06/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VOTRAN",
"AuthorizedOfficialFirstName": "LAM",
"AuthorizedOfficialMiddleName": "HAI",
"AuthorizedOfficialTitle": "PARTNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "510-790-4910",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "OPT 14241",
"LicenseNumberStateCode": "CA",
"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."
}
}
}
}