{
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"EntityType": "Organization",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GROUP W-A, INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6585 126TH AVE",
"SecondLineMailingAddress": "STE D1",
"MailingAddressCityName": "LARGO",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33773-2161",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "727-546-7220",
"MailingAddressFaxNumber": "727-546-6641",
"FirstLinePracticeLocationAddress": "6585 126TH AVE UNIT D1",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LARGO",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33773-1836",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "727-546-7220",
"PracticeLocationAddressFaxNumber": "727-546-6641",
"EnumerationDate": "12/11/2008",
"LastUpdateDate": "09/09/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BENTLEY",
"AuthorizedOfficialFirstName": "DAVID",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OPTICIAN",
"AuthorizedOfficialTelephoneNumber": "727-546-7220",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "OE 1526",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}