{
"Npi": {
"NPI": "1568799062",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MICHAEL ERICKSON, O.D.",
"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": "4957 LAKEMONT BLVD SE",
"SecondLineMailingAddress": "SUITE C-5",
"MailingAddressCityName": "BELLEVUE",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98006-7801",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "425-746-0908",
"MailingAddressFaxNumber": "815-346-3499",
"FirstLinePracticeLocationAddress": "4957 LAKEMONT BLVD SE",
"SecondLinePracticeLocationAddress": "SUITE C-5",
"PracticeLocationAddressCityName": "BELLEVUE",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98006-7801",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "425-746-0908",
"PracticeLocationAddressFaxNumber": "815-346-3499",
"EnumerationDate": "11/05/2009",
"LastUpdateDate": "11/05/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ERICKSON",
"AuthorizedOfficialFirstName": "MICHAEL",
"AuthorizedOfficialMiddleName": "DENNIS",
"AuthorizedOfficialTitle": "OPTOMETRIST/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "425-746-0908",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "OD00003260",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}