{
"Npi": {
"NPI": "1700070083",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LONG SIGHT, PC",
"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": "4251 TWIN MOUNTAIN DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "VINTON",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "24179-1021",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "540-875-8036",
"MailingAddressFaxNumber": "888-840-8937",
"FirstLinePracticeLocationAddress": "22 CAMPBELL AVE SE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ROANOKE",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "24011-1404",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "540-982-7890",
"PracticeLocationAddressFaxNumber": "540-982-7891",
"EnumerationDate": "08/30/2007",
"LastUpdateDate": "08/02/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LONG",
"AuthorizedOfficialFirstName": "JILDA",
"AuthorizedOfficialMiddleName": "EDEAN",
"AuthorizedOfficialTitle": "OPTOMETRIST/ OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "540-875-8036",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "0618001106",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "0618001106",
"LicenseNumberStateCode": "VA",
"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."
}
}
}
}