{
"Npi": {
"NPI": "1841633831",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "VISTAR EYE CENTER, INC",
"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": "PO BOX 1789",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROANOKE",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "24008-1789",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "540-855-3554",
"MailingAddressFaxNumber": "540-342-4373",
"FirstLinePracticeLocationAddress": "280 WESTLAKE RD",
"SecondLinePracticeLocationAddress": "PROFESSIONAL PARK BUILDING#2",
"PracticeLocationAddressCityName": "HARDY",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "24101-3967",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "540-346-2102",
"PracticeLocationAddressFaxNumber": "540-346-2109",
"EnumerationDate": "04/10/2013",
"LastUpdateDate": "12/15/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RUNYON",
"AuthorizedOfficialFirstName": "STACI",
"AuthorizedOfficialMiddleName": "E",
"AuthorizedOfficialTitle": "MANAGED CARE COORDINATOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "540-855-3554",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}