{
"Npi": {
"NPI": "1144530213",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GOTHENBURG-COZAD VISION CLINIC,P.C.",
"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 449",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GOTHENBURG",
"MailingAddressStateName": "NE",
"MailingAddressPostalCode": "69138-0449",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "308-537-2601",
"MailingAddressFaxNumber": "308-537-7211",
"FirstLinePracticeLocationAddress": "916 AVENUE F",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GOTHENBURG",
"PracticeLocationAddressStateName": "NE",
"PracticeLocationAddressPostalCode": "69138-2060",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "308-537-2601",
"PracticeLocationAddressFaxNumber": "308-537-7211",
"EnumerationDate": "10/07/2010",
"LastUpdateDate": "10/07/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GARRETT",
"AuthorizedOfficialFirstName": "LARRY",
"AuthorizedOfficialMiddleName": "D.",
"AuthorizedOfficialTitle": "OWNER/PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "308-537-2601",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "743",
"LicenseNumberStateCode": "NE",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}