{
"Npi": {
"NPI": "1285807685",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SOUTHERN OHIO EYE SURGICAL ASSOC., 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": "159 E 2ND ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHILLICOTHEE",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "45601-2526",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "740-773-6347",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1456 JACKSON PIKE",
"SecondLinePracticeLocationAddress": "SUITE 2",
"PracticeLocationAddressCityName": "GALLIPOLIS",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "45631-2602",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "740-446-0112",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/07/2008",
"LastUpdateDate": "09/03/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DEMICK",
"AuthorizedOfficialFirstName": "STEPHEN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "740-773-6347",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "27012133",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}