{
"Npi": {
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "BURNSIDE OPTICAL INC.",
"ParentOrgTIN": null,
"OrgName": "REYES OPTICA 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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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1571 SAINT NICHOLAS AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NEW YORK",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10040-4261",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "212-542-3937",
"MailingAddressFaxNumber": "212-543-3932",
"FirstLinePracticeLocationAddress": "1571 SAINT NICHOLAS AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NEW YORK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10040-4261",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "212-542-3937",
"PracticeLocationAddressFaxNumber": "212-543-3932",
"EnumerationDate": "03/29/2012",
"LastUpdateDate": "03/29/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "REYES",
"AuthorizedOfficialFirstName": "GUILLERMO",
"AuthorizedOfficialMiddleName": "Y",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LICENSED OPTICIAN",
"AuthorizedOfficialTelephoneNumber": "917-923-0792",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "156FX1800X",
"TaxonomyName": "Optician",
"LicenseNumber": "007379-1",
"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."
}
}
}
}