{
"Npi": {
"NPI": "1104264431",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "IDEAL VISION LLC",
"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": "4474 EVERHARD RD NW",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CANTON",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "44718-2418",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "330-494-4445",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4474 EVERHARD RD NW",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CANTON",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "44718-2418",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "330-494-4445",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/09/2013",
"LastUpdateDate": "06/09/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "AYERS",
"AuthorizedOfficialFirstName": "THERESA",
"AuthorizedOfficialMiddleName": "MARIE",
"AuthorizedOfficialTitle": "MEMBER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "330-806-2312",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "S 4032",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}