{
"Npi": {
"NPI": "1154542496",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SSJ INCORPORATED",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "500 THOMAS MORE PKWY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CRESTVIEW HILLS",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "41017-3454",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "859-341-5383",
"MailingAddressFaxNumber": "859-495-0607",
"FirstLinePracticeLocationAddress": "375 THOMAS MORE PKWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CRESTVIEW HILLS",
"PracticeLocationAddressStateName": "KY",
"PracticeLocationAddressPostalCode": "41017-2176",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "859-341-5383",
"PracticeLocationAddressFaxNumber": "859-341-3504",
"EnumerationDate": "05/02/2007",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MANDO",
"AuthorizedOfficialFirstName": "THOMAS",
"AuthorizedOfficialMiddleName": "C",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OPTICIAN",
"AuthorizedOfficialTelephoneNumber": "859-341-5383",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": null,
"LicenseNumberStateCode": "KY",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}