{
"Npi": {
"NPI": "1043459597",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "EYE MART FAMILY VISION CARE INC",
"ParentOrgTIN": null,
"OrgName": "EYEMART FAMILY VISION CARE 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": "9501 TAYLORSVILLE RD STE 106",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JEFFERSONTOWN",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "40299-2752",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "606-666-4585",
"MailingAddressFaxNumber": "606-666-4583",
"FirstLinePracticeLocationAddress": "100 HIGHWAY 15 S",
"SecondLinePracticeLocationAddress": "SUITE 108",
"PracticeLocationAddressCityName": "JACKSON",
"PracticeLocationAddressStateName": "KY",
"PracticeLocationAddressPostalCode": "41339-8636",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "606-666-4585",
"PracticeLocationAddressFaxNumber": "606-666-4583",
"EnumerationDate": "02/06/2009",
"LastUpdateDate": "04/04/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOODMAN",
"AuthorizedOfficialFirstName": "TERRY",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "PHYSICIAN / OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "502-499-2020",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"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."
}
}
}
}