{
"Npi": {
"NPI": "1427245042",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "VICTORIAN EYES",
"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": "1400 UNIVERSITY DR STE 102",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MARINETTE",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "54143-5106",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "715-732-2007",
"MailingAddressFaxNumber": "715-732-0936",
"FirstLinePracticeLocationAddress": "1400 UNIVERSITY DR STE 102",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MARINETTE",
"PracticeLocationAddressStateName": "WI",
"PracticeLocationAddressPostalCode": "54143-5106",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "715-732-2007",
"PracticeLocationAddressFaxNumber": "715-732-0936",
"EnumerationDate": "09/27/2007",
"LastUpdateDate": "09/27/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WEAVER",
"AuthorizedOfficialFirstName": "JENETTE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "715-732-2007",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": null,
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}