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1114084324 NPI number — TWO RIVERS EYE CLINIC

NPI Number: 1114084324
Health Care Provider/Practitioner: TWO RIVERS EYE CLINIC

Information about “1114084324” NPI (TWO RIVERS EYE CLINIC) exists in 1114084324 in HTML format HTML  |  1114084324 in plain Text format TXT  |  1114084324 in PDF (Portable Document Format) PDF  |  1114084324 in an XML format XML  formats.

NPI Number : 1114084324 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114084324",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "TWO RIVERS EYE CLINIC",
    "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 1900",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MANITOWOC",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "54221-1900",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "920-684-4429",
    "MailingAddressFaxNumber": "920-684-6892",
    "FirstLinePracticeLocationAddress": "1603 WASHINGTON ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TWO RIVERS",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "54241-3021",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "920-793-2725",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/03/2007",
    "LastUpdateDate": "08/22/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GAINEY",
    "AuthorizedOfficialFirstName": "STEVEN",
    "AuthorizedOfficialMiddleName": "P",
    "AuthorizedOfficialTitle": "OPHTHALMOLOGIST",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.D.",
    "AuthorizedOfficialTelephoneNumber": "920-684-4429",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "156FX1800X",
          "TaxonomyName": "Optician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207W00000X",
          "TaxonomyName": "Ophthalmology Physician",
          "LicenseNumber": "44214-020",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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