{
"Npi": {
"NPI": "1518266568",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EXCEL LASER VISION INSTITUTE",
"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": "16542 VENTURA BLVD.",
"SecondLineMailingAddress": "SUITE 400",
"MailingAddressCityName": "ENCINO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91436-5045",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "818-907-8606",
"MailingAddressFaxNumber": "818-379-9786",
"FirstLinePracticeLocationAddress": "16542 VENTURA BLVD",
"SecondLinePracticeLocationAddress": "400",
"PracticeLocationAddressCityName": "ENCINO",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91436-2005",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "818-907-8606",
"PracticeLocationAddressFaxNumber": "818-379-9786",
"EnumerationDate": "03/16/2011",
"LastUpdateDate": "03/16/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MOOSA",
"AuthorizedOfficialFirstName": "FERZAAD",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CHIEF SURGEON",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "818-907-8606",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QS0132X",
"TaxonomyName": "Ophthalmologic Surgery Clinic/Center",
"LicenseNumber": "A60007",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}