{
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"EIN": null,
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"OrgName": "VILLA OPTOMETRY, INC.",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"FirstLineMailingAddress": "531 TELEGRAPH CANYON RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHULA VISTA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91910-6436",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "619-482-2020",
"MailingAddressFaxNumber": "619-482-2671",
"FirstLinePracticeLocationAddress": "531 TELEGRAPH CANYON RD",
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"PracticeLocationAddressCityName": "CHULA VISTA",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "619-482-2020",
"PracticeLocationAddressFaxNumber": "619-482-2671",
"EnumerationDate": "09/15/2015",
"LastUpdateDate": "04/17/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VILLA",
"AuthorizedOfficialFirstName": "ANGELICA",
"AuthorizedOfficialMiddleName": "MARIE",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "858-260-9208",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "10561 T",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "152W00000X",
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}
]
},
"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."
}
}
}
}