{
"Npi": {
"NPI": "1679465041",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "CHESAPEAKE EYE CARE & LASER CENTER, LLC",
"ParentOrgTIN": null,
"OrgName": "CHESAPEAKE EYE CARE AND LASER CENTER, 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": "2661 RIVA RD STE 1030",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ANNAPOLIS",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21401-7131",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "410-571-8733",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3110 LORD BALTIMORE DR STE 103",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BALTIMORE",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21244-2644",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "410-277-3937",
"PracticeLocationAddressFaxNumber": "410-281-9388",
"EnumerationDate": "07/18/2025",
"LastUpdateDate": "07/18/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WALLECH",
"AuthorizedOfficialFirstName": "KRISTA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CREDENTIALING SPECIALIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "443-228-6971",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207W00000X",
"TaxonomyName": "Ophthalmology Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}