{
"Npi": {
"NPI": "1306035936",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DALTON EYE CENTER, 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": "1510 N THORNTON AVE",
"SecondLineMailingAddress": "SUITE 210",
"MailingAddressCityName": "DALTON",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30720-8517",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "706-277-2077",
"MailingAddressFaxNumber": "706-277-2021",
"FirstLinePracticeLocationAddress": "1510 N THORNTON AVE",
"SecondLinePracticeLocationAddress": "SUITE 210",
"PracticeLocationAddressCityName": "DALTON",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30720-8517",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "706-277-2077",
"PracticeLocationAddressFaxNumber": "706-277-2021",
"EnumerationDate": "10/19/2007",
"LastUpdateDate": "10/19/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BATES",
"AuthorizedOfficialFirstName": "KIMBERLY",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LDO",
"AuthorizedOfficialTelephoneNumber": "706-277-2077",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "LDO2049",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}