{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EYEWEAR BY DESIGN, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
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"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1410 UNION ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAFAYETTE",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "47904-2060",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "765-423-4646",
"MailingAddressFaxNumber": "765-423-1149",
"FirstLinePracticeLocationAddress": "1410 UNION ST",
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"PracticeLocationAddressCityName": "LAFAYETTE",
"PracticeLocationAddressStateName": "IN",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "765-423-4646",
"PracticeLocationAddressFaxNumber": "765-423-1149",
"EnumerationDate": "11/28/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MATTINGLY",
"AuthorizedOfficialFirstName": "THOMAS",
"AuthorizedOfficialMiddleName": "PAUL",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "765-423-4646",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}