{
"Npi": {
"NPI": "1124117973",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EYECARE OF VERMONT, PLC",
"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": "230 COLLEGE ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BURLINGTON",
"MailingAddressStateName": "VT",
"MailingAddressPostalCode": "05401-8352",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "802-658-3330",
"MailingAddressFaxNumber": "802-658-7464",
"FirstLinePracticeLocationAddress": "230 COLLEGE ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BURLINGTON",
"PracticeLocationAddressStateName": "VT",
"PracticeLocationAddressPostalCode": "05401-8352",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "802-658-3330",
"PracticeLocationAddressFaxNumber": "802-658-7464",
"EnumerationDate": "10/12/2006",
"LastUpdateDate": "03/13/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ERIKSSON",
"AuthorizedOfficialFirstName": "JON",
"AuthorizedOfficialMiddleName": "D",
"AuthorizedOfficialTitle": "OWNER MANAGER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "802-878-5509",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "152WL0500X",
"TaxonomyName": "Low Vision Rehabilitation Optometrist",
"LicenseNumber": "030-0000265",
"LicenseNumberStateCode": "VT",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "152WL0500X",
"TaxonomyName": "Low Vision Rehabilitation Optometrist",
"LicenseNumber": "030-0000293",
"LicenseNumberStateCode": "VT",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "030-0000156",
"LicenseNumberStateCode": "VT",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "030-0000338",
"LicenseNumberStateCode": "VT",
"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."
},
{
"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."
}
]
}
}
}