{
"Npi": {
"NPI": "1033162631",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "EYE CARE, LLC",
"ParentOrgTIN": null,
"OrgName": "EYE SURGERY CENTER-NORTHLAND LLC",
"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": "4801CLIFF AVE",
"SecondLineMailingAddress": "SUITE 100",
"MailingAddressCityName": "INDEPENDENCE",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "64055",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "816-478-1230",
"MailingAddressFaxNumber": "816-350-4585",
"FirstLinePracticeLocationAddress": "9401 N OAK TRFY",
"SecondLinePracticeLocationAddress": "SUITE 124",
"PracticeLocationAddressCityName": "KANSAS CITY",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "64155-2233",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "816-478-1230",
"PracticeLocationAddressFaxNumber": "816-350-4585",
"EnumerationDate": "05/18/2006",
"LastUpdateDate": "07/03/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HAMILTON",
"AuthorizedOfficialFirstName": "MELINDA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "EXECUTIVE ASSISTANT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "816-350-4536",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": "191",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}