{
"Npi": {
"NPI": "1700018363",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KLS OPTICAL 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": "215 ELTON HILLS DR NW",
"SecondLineMailingAddress": "#26",
"MailingAddressCityName": "ROCHESTER",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55901-2482",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "507-536-9649",
"MailingAddressFaxNumber": "507-216-4874",
"FirstLinePracticeLocationAddress": "215 ELTON HILLS DR NW",
"SecondLinePracticeLocationAddress": "#26",
"PracticeLocationAddressCityName": "ROCHESTER",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55901-2482",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "507-536-9649",
"PracticeLocationAddressFaxNumber": "507-216-4874",
"EnumerationDate": "08/17/2009",
"LastUpdateDate": "08/17/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STELLMAKER",
"AuthorizedOfficialFirstName": "KRISTEN",
"AuthorizedOfficialMiddleName": "K",
"AuthorizedOfficialTitle": "CO-OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "507-536-9649",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "9772026",
"LicenseNumberStateCode": "MN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}