{
"Npi": {
"NPI": "1245357862",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EYE CLINIC OF BELLEVUE LTD PS",
"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": "1300 116TH AVE NE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BELLEVUE",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98004-3808",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "425-455-1031",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3236 78TH AVE SE STE 102",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MERCER ISLAND",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98040-3500",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "206-232-0322",
"PracticeLocationAddressFaxNumber": "206-232-4751",
"EnumerationDate": "03/26/2007",
"LastUpdateDate": "06/19/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "POLZIN",
"AuthorizedOfficialFirstName": "KARIN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MANAGER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "425-454-3133",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "600047406",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}