{
"Npi": {
"NPI": "1104855287",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EYECARE CENTERS OF AITKIN & MCGREGOR OPTOMETRISTS, PA",
"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": "312 MINNESOTA AVE N",
"SecondLineMailingAddress": "SUITE 1",
"MailingAddressCityName": "AITKIN",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "56431",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "218-927-3213",
"MailingAddressFaxNumber": "218-927-2266",
"FirstLinePracticeLocationAddress": "312 MINNESOTA AVE. N",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "AITKIN",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "56431-1414",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "218-927-3213",
"PracticeLocationAddressFaxNumber": "218-927-2266",
"EnumerationDate": "07/01/2006",
"LastUpdateDate": "12/03/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KINZER",
"AuthorizedOfficialFirstName": "STEVEN",
"AuthorizedOfficialMiddleName": "ANTHONY",
"AuthorizedOfficialTitle": "OWNER/PARTNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "218-927-3213",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "1998",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "2588",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
]
}
}
}