{
"Npi": {
"NPI": "1255477386",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FORESIGHT OPTICAL INC",
"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": "PO BOX 1298",
"SecondLineMailingAddress": "N91 W20810 HILLVIEW DR.",
"MailingAddressCityName": "MENOMONEE FALLS",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53052-1298",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "414-915-3526",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7532 PERSHING BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KENOSHA",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53142-4316",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "262-694-3400",
"PracticeLocationAddressFaxNumber": "262-694-9456",
"EnumerationDate": "01/29/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GALLE",
"AuthorizedOfficialFirstName": "DONALD",
"AuthorizedOfficialMiddleName": "JOSEPH",
"AuthorizedOfficialTitle": "PRESIDENT-OPTICIAN",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "262-694-2400",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "LICENSE NOT REQUIRED",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}