{
"Npi": {
"NPI": "1679974075",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FORESIGHT OPTOMETRY OF NY, PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "20836 CROSS ISLAND PKWY",
"SecondLineMailingAddress": "2ND FL",
"MailingAddressCityName": "BAYSIDE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11360-1187",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-224-1833",
"MailingAddressFaxNumber": "718-224-1877",
"FirstLinePracticeLocationAddress": "20836 CROSS ISLAND PKWY",
"SecondLinePracticeLocationAddress": "2ND FL",
"PracticeLocationAddressCityName": "BAYSIDE",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11360-1187",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-224-1833",
"PracticeLocationAddressFaxNumber": "718-224-1877",
"EnumerationDate": "09/05/2014",
"LastUpdateDate": "06/12/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHEN",
"AuthorizedOfficialFirstName": "ARTHUR",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OPTOMETRIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "646-573-2039",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "TUV007443",
"LicenseNumberStateCode": "NY",
"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."
}
}
}
}