{
"Npi": {
"NPI": "1619173804",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MIDLANDS VISION ASSOCIATES, PC",
"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": "P.O. BOX 21203",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COLUMBIA",
"MailingAddressStateName": "SC",
"MailingAddressPostalCode": "29221-1203",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "803-750-4949",
"MailingAddressFaxNumber": "803-750-7172",
"FirstLinePracticeLocationAddress": "1326 BUSH RIVER RD",
"SecondLinePracticeLocationAddress": "AT WALMART VISION CENTER",
"PracticeLocationAddressCityName": "COLUMBIA",
"PracticeLocationAddressStateName": "SC",
"PracticeLocationAddressPostalCode": "29210-6804",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "803-750-4949",
"PracticeLocationAddressFaxNumber": "803-750-7172",
"EnumerationDate": "06/25/2007",
"LastUpdateDate": "04/25/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BHARADIA",
"AuthorizedOfficialFirstName": "MOHAMED",
"AuthorizedOfficialMiddleName": "SHABIR",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "803-750-4949",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "1047",
"LicenseNumberStateCode": "SC",
"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."
}
}
}
}