{
"Npi": {
"NPI": "1881832962",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SHEA OPTOMETRIC CORPORATION",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2200 HARBOR BLVD",
"SecondLineMailingAddress": "STE D-130",
"MailingAddressCityName": "COSTA MESA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92627-2501",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "949-642-7882",
"MailingAddressFaxNumber": "949-642-7792",
"FirstLinePracticeLocationAddress": "2200 HARBOR BLVD",
"SecondLinePracticeLocationAddress": "STE D-130",
"PracticeLocationAddressCityName": "COSTA MESA",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92627-2501",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "949-642-7882",
"PracticeLocationAddressFaxNumber": "949-642-7792",
"EnumerationDate": "01/28/2009",
"LastUpdateDate": "03/03/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHEA",
"AuthorizedOfficialFirstName": "JACK",
"AuthorizedOfficialMiddleName": "C.",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "949-642-7882",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QC1500X",
"TaxonomyName": "Community Health Clinic/Center",
"LicenseNumber": "11538TPL",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QM2500X",
"TaxonomyName": "Medical Specialty Clinic/Center",
"LicenseNumber": "11538TPL",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}