{
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"EIN": null,
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"IsOrgSubpart": "N",
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"FirstLineMailingAddress": "4002 CHESTNUT ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PHILADELPHIA",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19104-3020",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "215-921-4871",
"MailingAddressFaxNumber": "215-921-4891",
"FirstLinePracticeLocationAddress": "4002 CHESTNUT ST",
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"PracticeLocationAddressCityName": "PHILADELPHIA",
"PracticeLocationAddressStateName": "PA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "215-921-4871",
"PracticeLocationAddressFaxNumber": "215-921-4891",
"EnumerationDate": "09/09/2013",
"LastUpdateDate": "09/09/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NIGRO",
"AuthorizedOfficialFirstName": "WILLIAM",
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"AuthorizedOfficialTitle": "MANAGER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "215-921-4871",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "156FX1800X",
"TaxonomyName": "Optician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}