{
"Npi": {
"NPI": "1629128475",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "E WINGO & P COLCHISKI PTR",
"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": "2437 E FORT KING ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OCALA",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34471-2558",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "352-629-2422",
"MailingAddressFaxNumber": "352-732-0177",
"FirstLinePracticeLocationAddress": "2437 E FORT KING ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OCALA",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34471-2558",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "352-629-2422",
"PracticeLocationAddressFaxNumber": "352-732-0177",
"EnumerationDate": "01/12/2007",
"LastUpdateDate": "06/18/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WINGO",
"AuthorizedOfficialFirstName": "PENELOPE",
"AuthorizedOfficialMiddleName": "COLCHISKI",
"AuthorizedOfficialTitle": "COOWNER-MANAGER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "352-629-2422",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "ME0028326",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}