{
"Npi": {
"NPI": "1942754700",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "2020 EYEDR",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1505 STONE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CARROLLTON",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75010-1147",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "630-452-6290",
"MailingAddressFaxNumber": "888-619-2009",
"FirstLinePracticeLocationAddress": "1251 E SOUTHLAKE BLVD",
"SecondLinePracticeLocationAddress": "SUITE 331",
"PracticeLocationAddressCityName": "SOUTHLAKE",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76092-6478",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "630-452-6290",
"PracticeLocationAddressFaxNumber": "888-619-2009",
"EnumerationDate": "08/10/2016",
"LastUpdateDate": "08/10/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ABRAHAM",
"AuthorizedOfficialFirstName": "MANOJ",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OPTOMETRIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "630-452-6290",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "8563",
"LicenseNumberStateCode": "TX",
"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."
}
}
}
}