{
"Npi": {
"NPI": "1013049832",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COMBS EYECARE AND EYEWEAR LTD",
"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": "504 HILLGROVE AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WESTERN SPRINGS",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60558-1481",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "708-286-1100",
"MailingAddressFaxNumber": "708-286-1103",
"FirstLinePracticeLocationAddress": "504 HILLGROVE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WESTERN SPRINGS",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60558-1481",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "708-286-1100",
"PracticeLocationAddressFaxNumber": "708-286-1103",
"EnumerationDate": "03/09/2007",
"LastUpdateDate": "06/18/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COMBS",
"AuthorizedOfficialFirstName": "IRENE",
"AuthorizedOfficialMiddleName": "DOMENICA",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "708-286-1100",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "046008409",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}