{
"Npi": {
"NPI": "1972712008",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SENECA OPTICIANS 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": "1598 SANDIFER BLVD",
"SecondLineMailingAddress": "SUITE J",
"MailingAddressCityName": "SENECA",
"MailingAddressStateName": "SC",
"MailingAddressPostalCode": "29678-0929",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "864-882-3255",
"MailingAddressFaxNumber": "864-882-3591",
"FirstLinePracticeLocationAddress": "1598 SANDIFER BLVD",
"SecondLinePracticeLocationAddress": "SUITE J",
"PracticeLocationAddressCityName": "SENECA",
"PracticeLocationAddressStateName": "SC",
"PracticeLocationAddressPostalCode": "29678-0929",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "864-882-3255",
"PracticeLocationAddressFaxNumber": "864-882-3591",
"EnumerationDate": "05/22/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HEATON",
"AuthorizedOfficialFirstName": "LAURA",
"AuthorizedOfficialMiddleName": "MEADE",
"AuthorizedOfficialTitle": "OPTICIAN",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LDO LICENSED DISPENS",
"AuthorizedOfficialTelephoneNumber": "864-882-3255",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "156FX1800X",
"TaxonomyName": "Optician",
"LicenseNumber": "739",
"LicenseNumberStateCode": "SC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}