{
"Npi": {
"NPI": "1164711420",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LAKE PROSTHETICS AND RESEARCH, LLC",
"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": "350 WESTPARK WAY",
"SecondLineMailingAddress": "SUITE 108",
"MailingAddressCityName": "EULESS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76040-3964",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "817-358-1500",
"MailingAddressFaxNumber": "682-224-8430",
"FirstLinePracticeLocationAddress": "350 WESTPARK WAY",
"SecondLinePracticeLocationAddress": "SUITE 108",
"PracticeLocationAddressCityName": "EULESS",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76040-3964",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "817-358-1500",
"PracticeLocationAddressFaxNumber": "682-224-8430",
"EnumerationDate": "04/06/2011",
"LastUpdateDate": "08/31/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LAKE",
"AuthorizedOfficialFirstName": "JOSEPH",
"AuthorizedOfficialMiddleName": "CHRISTOPHER",
"AuthorizedOfficialTitle": "CHIEF CLINICAL DIRECTOR",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "L/CPO, FAAOP",
"AuthorizedOfficialTelephoneNumber": "817-358-1500",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335E00000X",
"TaxonomyName": "Prosthetic/Orthotic Supplier",
"LicenseNumber": "80",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}