{
"Npi": {
"NPI": "1528147048",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WALNUT CREEK OPTOMETRY GROUP",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1844 SAN MIGUEL DR",
"SecondLineMailingAddress": "SUITE 312",
"MailingAddressCityName": "WALNUT CREEK",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "94596-4963",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "925-934-4313",
"MailingAddressFaxNumber": "925-943-1907",
"FirstLinePracticeLocationAddress": "1844 SAN MIGUEL DR",
"SecondLinePracticeLocationAddress": "SUITE 312",
"PracticeLocationAddressCityName": "WALNUT CREEK",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94596-4963",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "925-934-4313",
"PracticeLocationAddressFaxNumber": "925-943-1907",
"EnumerationDate": "11/03/2006",
"LastUpdateDate": "10/26/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NGUYEN",
"AuthorizedOfficialFirstName": "BACH-KIM",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OPTOMETRIST /OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "925-934-4313",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "10544T",
"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."
}
}
}
}