{
"Npi": {
"NPI": "1295100204",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ACTIVE EYECARE LLC",
"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": "16968 W BELL RD",
"SecondLineMailingAddress": "SUITE 402",
"MailingAddressCityName": "SURPRISE",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85374-8943",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "623-214-0353",
"MailingAddressFaxNumber": "623-214-0693",
"FirstLinePracticeLocationAddress": "16968 W BELL RD",
"SecondLinePracticeLocationAddress": "SUITE 402",
"PracticeLocationAddressCityName": "SURPRISE",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85374-8943",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "623-214-0353",
"PracticeLocationAddressFaxNumber": "623-214-0693",
"EnumerationDate": "12/02/2015",
"LastUpdateDate": "12/02/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FECHTEL",
"AuthorizedOfficialFirstName": "MARK",
"AuthorizedOfficialMiddleName": "EDWARD",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "623-214-0353",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "1117",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}