{
"Npi": {
"NPI": "1487104600",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BRUCE COOK PROSTHETICS",
"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": "2821 N BALLAS RD",
"SecondLineMailingAddress": "SUITE 215",
"MailingAddressCityName": "SAINT LOUIS",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "63131-2321",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "314-567-7585",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2821 N BALLAS RD",
"SecondLinePracticeLocationAddress": "SUITE 215",
"PracticeLocationAddressCityName": "SAINT LOUIS",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "63131-2321",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "314-567-7585",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/12/2016",
"LastUpdateDate": "10/12/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COOK",
"AuthorizedOfficialFirstName": "WRAY",
"AuthorizedOfficialMiddleName": "BRUCE",
"AuthorizedOfficialTitle": "OWNER/OCULARIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "B.C.O.",
"AuthorizedOfficialTelephoneNumber": "314-567-7585",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332BC3200X",
"TaxonomyName": "Customized Equipment (DME)",
"LicenseNumber": "156FX1700X",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}