1861704751 NPI number — AMANDA RENAE CRUM O.D, M.S

NPI Number: 1861704751
Health Care Provider/Practitioner: AMANDA RENAE CRUM O.D, M.S

NPI Number : 1861704751 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1861704751",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CRUM",
    "FirstName": "AMANDA",
    "MiddleName": "RENAE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "O.D, M.S",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MARKS",
    "OtherFirstName": "AMANDA",
    "OtherMiddleName": "RENAE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "O.D.,M.S.",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 64481",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BALTIMORE",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "21264-4481",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "410-614-5115",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "600 N WOLFE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BALTIMORE",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "21287-0005",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "410-614-5115",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/08/2010",
    "LastUpdateDate": "06/09/2017",
    "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": "5961",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "TA2276",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}