{
"Npi": {
"NPI": "1255756128",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "OHIO EYE ASSOCIATES, INC",
"ParentOrgTIN": null,
"OrgName": "OHIO EYE OPTOMETRIC, 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": "466 S TRIMBLE RD",
"SecondLineMailingAddress": "SUITE D",
"MailingAddressCityName": "MANSFIELD",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "44906-3416",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "419-756-8000",
"MailingAddressFaxNumber": "419-756-7100",
"FirstLinePracticeLocationAddress": "129 S WALNUT ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BUCYRUS",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "44820-2325",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "419-756-8000",
"PracticeLocationAddressFaxNumber": "419-756-7100",
"EnumerationDate": "02/28/2014",
"LastUpdateDate": "03/08/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SKARIE",
"AuthorizedOfficialFirstName": "JONATHAN",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "419-756-8000",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "59900093",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}