{
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"EIN": null,
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"OrgName": "WESLEY CHANT, OD",
"LastName": null,
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"MiddleName": null,
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"FirstLineMailingAddress": "3943 IRVINE BLVD # 87",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "IRVINE",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92602-2400",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "18414 E. COLIMA RD",
"SecondLinePracticeLocationAddress": "SUITE U",
"PracticeLocationAddressCityName": "ROWLAND HEIGHTS",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "626-839-0358",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/14/2007",
"LastUpdateDate": "06/14/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHANT",
"AuthorizedOfficialFirstName": "WESLEY",
"AuthorizedOfficialMiddleName": "JUAN",
"AuthorizedOfficialTitle": "O.D.",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "626-236-8571",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Optometrist",
"LicenseNumber": "12553",
"LicenseNumberStateCode": "CA",
"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."
}
}
}
}