{
"Npi": {
"NPI": "1659531309",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PRISON REHABILITATIVE INDUSTRIES DIVERSIFIED ENTERPRISES, INC",
"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": "12425 28TH ST N",
"SecondLineMailingAddress": "SUITE 300",
"MailingAddressCityName": "ST PETERSBURG",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33716-1844",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "727-572-1987",
"MailingAddressFaxNumber": "727-570-3378",
"FirstLinePracticeLocationAddress": "20421 SHERIDAN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FT LAUDERDALE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33332-2300",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "800-523-1766",
"PracticeLocationAddressFaxNumber": "813-890-2103",
"EnumerationDate": "06/16/2008",
"LastUpdateDate": "06/16/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RADANOVICH",
"AuthorizedOfficialFirstName": "PETER",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CHIEF FINANCIAL OFFICER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "727-556-3370",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "S. 2220",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}