{
"Npi": {
"NPI": "1205956596",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GLADWIN OPTOMETRIC CENTER INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "202 E CEDAR AVE",
"SecondLineMailingAddress": "PO276",
"MailingAddressCityName": "GLADWIN",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48624-2261",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "989-426-8272",
"MailingAddressFaxNumber": "989-426-3701",
"FirstLinePracticeLocationAddress": "202 E CEDAR AVE",
"SecondLinePracticeLocationAddress": "PO 276",
"PracticeLocationAddressCityName": "GLADWIN",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48624-2261",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "989-422-6827",
"PracticeLocationAddressFaxNumber": "989-426-3701",
"EnumerationDate": "03/30/2007",
"LastUpdateDate": "07/25/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TROMBLEY",
"AuthorizedOfficialFirstName": "STEVEN",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "DOCTOR OF OPTOMETRY",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "989-426-8272",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "3212",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}