{
"Npi": {
"NPI": "1659715720",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "OPTICA L.M. , 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": "PO BOX 703",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TOA BAJA",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00951-0703",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-798-0575",
"MailingAddressFaxNumber": "787-798-0575",
"FirstLinePracticeLocationAddress": "CARR 863 KM 1.2",
"SecondLinePracticeLocationAddress": "BO PAJAROS",
"PracticeLocationAddressCityName": "TOA BAJA",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00949",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-798-0575",
"PracticeLocationAddressFaxNumber": "787-798-0575",
"EnumerationDate": "04/19/2013",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MALDONADO",
"AuthorizedOfficialFirstName": "CAROL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "787-798-0575",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "609",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": null,
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}