{
"Npi": {
"NPI": "1699070003",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "B&J OPTICAL BOUTIQUE INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "318 CALLE PARAGUAY",
"SecondLineMailingAddress": "EL PRADO",
"MailingAddressCityName": "SAN JUAN",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00917-4029",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-674-4460",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "313 AVE BARBOSA",
"SecondLinePracticeLocationAddress": "ESQUINA CALLE PARAGUAY",
"PracticeLocationAddressCityName": "SAN JUAN",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00917-3307",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-674-4460",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/14/2011",
"LastUpdateDate": "01/18/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MARTINEZ",
"AuthorizedOfficialFirstName": "PEDRO",
"AuthorizedOfficialMiddleName": "JUAN",
"AuthorizedOfficialTitle": "OPTICIAN",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OPTICIAN",
"AuthorizedOfficialTelephoneNumber": "787-674-4460",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "156FX1800X",
"TaxonomyName": "Optician",
"LicenseNumber": "416",
"LicenseNumberStateCode": "PR",
"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."
}
}
}
}