{
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"OrgName": "MICHAEL K EDELSTEIN OD, PC",
"LastName": null,
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"MiddleName": null,
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"FirstLineMailingAddress": "446 MOODY ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WALTHAM",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "02453-0415",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "413-509-1000",
"MailingAddressFaxNumber": "413-509-1003",
"FirstLinePracticeLocationAddress": "446 MOODY ST",
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"PracticeLocationAddressCityName": "WALTHAM",
"PracticeLocationAddressStateName": "MA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "781-899-3200",
"PracticeLocationAddressFaxNumber": "781-894-4645",
"EnumerationDate": "12/15/2005",
"LastUpdateDate": "01/29/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "EDELSTEIN",
"AuthorizedOfficialFirstName": "MICHAEL",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "781-899-3200",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Optometrist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}