{
"Npi": {
"NPI": "1306096417",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ALTERNATIVE VISION SERVICES",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1612 COMMONWEALTH DR",
"SecondLineMailingAddress": "#4",
"MailingAddressCityName": "FORT ATKINSON",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "53538-3147",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "920-397-7094",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1612 COMMONWEALTH DR",
"SecondLinePracticeLocationAddress": "#4",
"PracticeLocationAddressCityName": "FORT ATKINSON",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "53538-3147",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "920-397-7094",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/25/2008",
"LastUpdateDate": "09/25/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COOK",
"AuthorizedOfficialFirstName": "MARK",
"AuthorizedOfficialMiddleName": "F",
"AuthorizedOfficialTitle": "PROPRIETER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "920-390-9038",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "2358-035",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}