{
"Npi": {
"NPI": "1659811511",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EYECARE DOCTOR LLC",
"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": "1465 LANCASTER RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MANHEIM",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "17545-9768",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "717-879-6900",
"MailingAddressFaxNumber": "717-879-6901",
"FirstLinePracticeLocationAddress": "1172 GRAYSTONE RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MANHEIM",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "17545-8822",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "717-917-6363",
"PracticeLocationAddressFaxNumber": "717-459-3482",
"EnumerationDate": "02/26/2017",
"LastUpdateDate": "01/08/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HUDISH",
"AuthorizedOfficialFirstName": "CHERYL",
"AuthorizedOfficialMiddleName": "KAY",
"AuthorizedOfficialTitle": "OPTOMETRIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "717-917-6363",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "OET008805",
"LicenseNumberStateCode": "PA",
"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."
}
}
}
}