{
"Npi": {
"NPI": "1336485986",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LEAN VISIONS 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": "1505 STONE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CARROLLTON",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75010-1147",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1971 HIGHWAY 287 N",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MANSFIELD",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76063-8982",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "181-745-3759",
"PracticeLocationAddressFaxNumber": "888-619-2009",
"EnumerationDate": "12/28/2012",
"LastUpdateDate": "05/28/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ABRAHAM",
"AuthorizedOfficialFirstName": "MANOJ",
"AuthorizedOfficialMiddleName": "MATHEW",
"AuthorizedOfficialTitle": "OPTOMETRIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "630-452-6290",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "046009950",
"LicenseNumberStateCode": "IL",
"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."
}
}
}
}