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1770266314 NPI number — TAYLOR CHAMPAGNE

NPI Number: 1770266314
Health Care Provider/Practitioner: TAYLOR CHAMPAGNE

Information about “1770266314” NPI (TAYLOR CHAMPAGNE) exists in 1770266314 in HTML format HTML  |  1770266314 in plain Text format TXT  |  1770266314 in PDF (Portable Document Format) PDF  |  1770266314 in an XML format XML  formats.

NPI Number : 1770266314 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1770266314",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CHAMPAGNE",
    "FirstName": "TAYLOR",
    "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": "2 CONWAY CT APT 2E",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TROY",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "12180-2166",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "518-306-8428",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "767 TROY SCHENECTADY RD # 1",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LATHAM",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "12110-2446",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "518-690-7020",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/10/2023",
    "LastUpdateDate": "08/10/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "152W00000X",
        "TaxonomyName": "Optometrist",
        "LicenseNumber": "009879-01",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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