{
"Npi": {
"NPI": "1740390558",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "LASKE",
"FirstName": "NICOLE",
"MiddleName": "JANE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "OD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "KAISER PERMANENTE SUNSET MEDICAL OFFICE",
"SecondLineMailingAddress": "19400 NW EVERGREEN PWY",
"MailingAddressCityName": "HILLSBORO",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97124-7031",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "503-690-5005",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "KAISER PERMANENTE SUNSET MEDICAL OFFICE",
"SecondLinePracticeLocationAddress": "19400 NW EVERGREEN PWY",
"PracticeLocationAddressCityName": "HILLSBORO",
"PracticeLocationAddressStateName": "OR",
"PracticeLocationAddressPostalCode": "97124-7031",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "503-690-5005",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/30/2006",
"LastUpdateDate": "02/04/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "2783 ATI",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}