{
"Npi": {
"NPI": "1588951990",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CROSS",
"FirstName": "ERIC",
"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": "8499 E LOWRY BLVD APT 310",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DENVER",
"MailingAddressStateName": "CO",
"MailingAddressPostalCode": "80230-7266",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "219-229-4899",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "910 16TH ST STE 524",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DENVER",
"PracticeLocationAddressStateName": "CO",
"PracticeLocationAddressPostalCode": "80202-2921",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "303-534-8811",
"PracticeLocationAddressFaxNumber": "303-825-0109",
"EnumerationDate": "07/06/2011",
"LastUpdateDate": "09/05/2024",
"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": "0618002042",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "18003694A",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "0003046",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}