{
"Npi": {
"NPI": "1922376904",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MCCLOY OPTICAL, LLC",
"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": "140 W SPRING ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAINT MARYS",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "45885-2312",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "419-394-2397",
"MailingAddressFaxNumber": "419-394-2398",
"FirstLinePracticeLocationAddress": "140 W SPRING ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAINT MARYS",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "45885-2312",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "419-394-2397",
"PracticeLocationAddressFaxNumber": "419-394-2398",
"EnumerationDate": "12/06/2011",
"LastUpdateDate": "12/06/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCCLOY",
"AuthorizedOfficialFirstName": "DOUGLAS",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OPTOMETRIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "II",
"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "419-394-2397",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "152WC0802X",
"TaxonomyName": "Corneal and Contact Management Optometrist",
"LicenseNumber": "4665",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "4665",
"LicenseNumberStateCode": "OH",
"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."
},
{
"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."
}
]
}
}
}