{
"Npi": {
"NPI": "1407532542",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KAWAGUCHI",
"FirstName": "NEIL",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "OD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "11065 CHEROKEE LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LOLO",
"MailingAddressStateName": "MT",
"MailingAddressPostalCode": "59847-9683",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "509-308-1311",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3075 N RESERVE ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MISSOULA",
"PracticeLocationAddressStateName": "MT",
"PracticeLocationAddressPostalCode": "59808-1389",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "406-721-4646",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/23/2023",
"LastUpdateDate": "06/23/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "OPT-OPT-LIC-4849",
"LicenseNumberStateCode": "MT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}