{
"Npi": {
"NPI": "1548638141",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "W. CYNTHIA BLAYLOCK, OD, INC",
"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": "1955 MONUMENT BLVD",
"SecondLineMailingAddress": "SUITE 4-A",
"MailingAddressCityName": "CONCORD",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "94520-3873",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "925-326-0120",
"MailingAddressFaxNumber": "925-326-3120",
"FirstLinePracticeLocationAddress": "1955 MONUMENT BLVD",
"SecondLinePracticeLocationAddress": "SUITE 4-A",
"PracticeLocationAddressCityName": "CONCORD",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "94520-3873",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "925-326-0120",
"PracticeLocationAddressFaxNumber": "925-326-3120",
"EnumerationDate": "09/14/2015",
"LastUpdateDate": "02/22/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BLAYLOCK",
"AuthorizedOfficialFirstName": "WEISHING",
"AuthorizedOfficialMiddleName": "CYNTHIA",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "317-985-6420",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "OPT 14513 TPG",
"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."
}
}
}
}