{
"Npi": {
"NPI": "1689974669",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "20/20 OPTICAL DISPENSARY, INC.",
"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": "100 S MILITARY TRL STE 6",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DEERFIELD BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33442-3031",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "954-571-2022",
"MailingAddressFaxNumber": "954-571-2922",
"FirstLinePracticeLocationAddress": "100 S MILITARY TRL STE 6",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DEERFIELD BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33442-3031",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "954-571-2022",
"PracticeLocationAddressFaxNumber": "954-571-2922",
"EnumerationDate": "10/25/2010",
"LastUpdateDate": "10/25/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DWIN",
"AuthorizedOfficialFirstName": "GUILHERME",
"AuthorizedOfficialMiddleName": "WILLIAM",
"AuthorizedOfficialTitle": "OPTICIAN/ OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LDO",
"AuthorizedOfficialTelephoneNumber": "954-571-2022",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "1171",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}