NPI Code Detail JSON Logo

1114205788 NPI number — TRI STATE VISION CARE, PROF LLC

NPI Number: 1114205788
Health Care Provider/Practitioner: TRI STATE VISION CARE, PROF LLC

Information about “1114205788” NPI (TRI STATE VISION CARE, PROF LLC) exists in 1114205788 in HTML format HTML  |  1114205788 in plain Text format TXT  |  1114205788 in PDF (Portable Document Format) PDF  |  1114205788 in an XML format XML  formats.

NPI Number : 1114205788 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114205788",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "TRI STATE VISION CARE, PROF 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": "2709 ABBOTT CIR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "YANKTON",
    "MailingAddressStateName": "SD",
    "MailingAddressPostalCode": "57078-5330",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1601 CORNHUSKER DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SOUTH SIOUX CITY",
    "PracticeLocationAddressStateName": "NE",
    "PracticeLocationAddressPostalCode": "68776-3924",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "402-494-1498",
    "PracticeLocationAddressFaxNumber": "402-494-1594",
    "EnumerationDate": "07/29/2011",
    "LastUpdateDate": "07/29/2011",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SLOWEY",
    "AuthorizedOfficialFirstName": "LAURA",
    "AuthorizedOfficialMiddleName": "JOAN",
    "AuthorizedOfficialTitle": "OPTOMETRIST",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "O.D.",
    "AuthorizedOfficialTelephoneNumber": "605-660-3896",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "152W00000X",
        "TaxonomyName": "Optometrist",
        "LicenseNumber": "1355",
        "LicenseNumberStateCode": "NE",
        "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."
      }
    }
  }
}
                
            

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