{
"Npi": {
"NPI": "1891841599",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SELMA FAMILY PRACTICE OPTOMETRY, INC.",
"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": "32510 HIGHWAY 43",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "THOMASVILLE",
"MailingAddressStateName": "AL",
"MailingAddressPostalCode": "36784-1611",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "334-636-0016",
"MailingAddressFaxNumber": "334-636-9734",
"FirstLinePracticeLocationAddress": "32510 HIGHWAY 43N",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "THOMASVILLE",
"PracticeLocationAddressStateName": "AL",
"PracticeLocationAddressPostalCode": "36784-1622",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "334-636-0016",
"PracticeLocationAddressFaxNumber": "334-636-9734",
"EnumerationDate": "01/26/2007",
"LastUpdateDate": "10/25/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MAXWELL",
"AuthorizedOfficialFirstName": "LEROY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OPTOMETRIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "SR.",
"AuthorizedOfficialCredential": "O.D M.PH",
"AuthorizedOfficialTelephoneNumber": "334-872-2321",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "S435TA115",
"LicenseNumberStateCode": "AL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
}
}
}