{
"Npi": {
"NPI": "1215942792",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SPECTACLE SHOP, INC.",
"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": "20251 LONG LAKE DRIVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HAMMOND",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "70403-8607",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "985-520-5005",
"MailingAddressFaxNumber": "985-520-5060",
"FirstLinePracticeLocationAddress": "1047 MILLMONT ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHARLOTTESVILLE",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "22903-4866",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "434-979-7730",
"PracticeLocationAddressFaxNumber": "434-977-7512",
"EnumerationDate": "07/30/2006",
"LastUpdateDate": "08/13/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRIGHT",
"AuthorizedOfficialFirstName": "JON",
"AuthorizedOfficialMiddleName": "DAVID",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OPTICIAN",
"AuthorizedOfficialTelephoneNumber": "434-973-8636",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "1101000736",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}