{
"Npi": {
"NPI": "1922299320",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MIRANDA OPTOMETRY, P. C.",
"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": "3120 MONTANA DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PRESCOTT",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "86301-4626",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "928-443-1743",
"MailingAddressFaxNumber": "928-442-3120",
"FirstLinePracticeLocationAddress": "720 N MONTEZUMA ST STE C",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PRESCOTT",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "86301-2068",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "928-443-1743",
"PracticeLocationAddressFaxNumber": "928-442-3120",
"EnumerationDate": "08/09/2007",
"LastUpdateDate": "08/09/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MIRANDA",
"AuthorizedOfficialFirstName": "CARRIE",
"AuthorizedOfficialMiddleName": "JOY",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O. D.",
"AuthorizedOfficialTelephoneNumber": "928-443-1743",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "844",
"LicenseNumberStateCode": "AZ",
"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."
}
}
}
}