{
"Npi": {
"NPI": "1154421402",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BAZIN",
"FirstName": "BETH",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "O.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BAZIN",
"OtherFirstName": "BETH",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "O.D.",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "7235 W 79 STREET",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OVERLAND PARK",
"MailingAddressStateName": "KS",
"MailingAddressPostalCode": "66204-3664",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "816-333-1500",
"MailingAddressFaxNumber": "816-817-3769",
"FirstLinePracticeLocationAddress": "1441 E 104TH ST",
"SecondLinePracticeLocationAddress": "BLDG. 3 - SUITE 103",
"PracticeLocationAddressCityName": "KANSAS CITY",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "64131-4634",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "816-333-1500",
"PracticeLocationAddressFaxNumber": "816-943-0885",
"EnumerationDate": "09/25/2006",
"LastUpdateDate": "08/22/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "T03320",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "152WP0200X",
"TaxonomyName": "Pediatric Optometrist",
"LicenseNumber": "T03320",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "152WV0400X",
"TaxonomyName": "Vision Therapy Optometrist",
"LicenseNumber": "T03320",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "2211",
"LicenseNumberStateCode": "KS",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}