{
"Npi": {
"NPI": "1003913419",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KLASSY EYES INC",
"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": "4036 NW 3RD AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BOCA RATON",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33431-4101",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "561-394-5815",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "KLASSY EYES OPTICAL",
"SecondLinePracticeLocationAddress": "7050 W PALMETTO PARK ROAD SUITE36",
"PracticeLocationAddressCityName": "BOCA RATON",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33433-3463",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "561-394-8777",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/20/2006",
"LastUpdateDate": "07/29/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DI CERBO",
"AuthorizedOfficialFirstName": "KENNETH",
"AuthorizedOfficialMiddleName": "ALAN",
"AuthorizedOfficialTitle": "PRESIDENT/OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OPTICIAN",
"AuthorizedOfficialTelephoneNumber": "561-394-8777",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "2782",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}