{
"Npi": {
"NPI": "1649600453",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "OM EYECARE, INC.",
"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": "208 LENOX AVE # 103",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WESTFIELD",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07090-5120",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "908-315-7907",
"MailingAddressFaxNumber": "908-546-5682",
"FirstLinePracticeLocationAddress": "1290 US HIGHWAY 22 E",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NORTH PLAINFIELD",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "07060-3518",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "908-546-5681",
"PracticeLocationAddressFaxNumber": "908-546-5682",
"EnumerationDate": "11/14/2013",
"LastUpdateDate": "04/29/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHUKLA",
"AuthorizedOfficialFirstName": "MILI",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OD/PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "908-546-5681",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "302F00000X",
"TaxonomyName": "Exclusive Provider Organization",
"LicenseNumber": "27OA00601300",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}