{
"Npi": {
"NPI": "1104158997",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "L. H. KIMBALL, 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": "PO BOX 8427",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BRATTLEBORO",
"MailingAddressStateName": "VT",
"MailingAddressPostalCode": "05304-8427",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "802-257-7453",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1222 PUTNEY RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BRATTLEBORO",
"PracticeLocationAddressStateName": "VT",
"PracticeLocationAddressPostalCode": "05301-9000",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "802-257-7453",
"PracticeLocationAddressFaxNumber": "802-254-6900",
"EnumerationDate": "02/04/2010",
"LastUpdateDate": "06/11/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KIMBALL",
"AuthorizedOfficialFirstName": "LYNDE",
"AuthorizedOfficialMiddleName": "H.",
"AuthorizedOfficialTitle": "MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "802-257-7453",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "030 0000113",
"LicenseNumberStateCode": "VT",
"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."
}
}
}
}