{
"Npi": {
"NPI": "1629212006",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DOMINICK A MARINO OD PA",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1983 JUNO ISLES BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORTH PALM BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33408-2422",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "561-622-3671",
"MailingAddressFaxNumber": "561-622-5334",
"FirstLinePracticeLocationAddress": "4530 PGA BLVD",
"SecondLinePracticeLocationAddress": "SUITE105",
"PracticeLocationAddressCityName": "PALM BEACH GARDENS",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33418-3912",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "561-622-3671",
"PracticeLocationAddressFaxNumber": "561-622-5334",
"EnumerationDate": "04/29/2009",
"LastUpdateDate": "03/29/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MARINO",
"AuthorizedOfficialFirstName": "DOMINICK",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "PRESIDENT /OPTOMETRIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "561-799-2461",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "OPC 2073",
"LicenseNumberStateCode": "FL",
"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."
}
}
}
}