{
"Npi": {
"NPI": "1639557952",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CRYSTAL VISION CARE, PLLC",
"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": "3829 177TH PL SW",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LYNNWOOD",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98037-7528",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-469-1478",
"MailingAddressFaxNumber": "425-640-7518",
"FirstLinePracticeLocationAddress": "18700 ALDERWOOD MALL PKWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LYNNWOOD",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98037",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "425-640-6532",
"PracticeLocationAddressFaxNumber": "425-640-7518",
"EnumerationDate": "05/07/2015",
"LastUpdateDate": "09/07/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KIM",
"AuthorizedOfficialFirstName": "CAROL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OPTOMETRIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "714-469-1478",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "OD60188672",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}