{
"Npi": {
"NPI": "1457537383",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JERRY D REDWINE",
"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": "PO BOX 1011",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MULESHOE",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "79347-1011",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "806-272-4705",
"MailingAddressFaxNumber": "806-272-3824",
"FirstLinePracticeLocationAddress": "111 E 3RD ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MULESHOE",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "79347-3801",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "806-272-4705",
"PracticeLocationAddressFaxNumber": "806-272-3824",
"EnumerationDate": "01/09/2008",
"LastUpdateDate": "01/10/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "REDWINE",
"AuthorizedOfficialFirstName": "DONNA",
"AuthorizedOfficialMiddleName": "JEAN",
"AuthorizedOfficialTitle": "OFFICE MANAGER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "806-272-4705",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "2296T",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}