{
"Npi": {
"NPI": "1750661005",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JOHN IMM PROSTHETICS, LLC",
"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": "5593 STEWART ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MILTON",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32570-4344",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "850-380-8184",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3 W GARDEN ST STE 404",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PENSACOLA",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32502-5633",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "850-380-8184",
"PracticeLocationAddressFaxNumber": "850-434-1830",
"EnumerationDate": "08/18/2011",
"LastUpdateDate": "05/07/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "IMM",
"AuthorizedOfficialFirstName": "JOHN",
"AuthorizedOfficialMiddleName": "TOBY",
"AuthorizedOfficialTitle": "OCULARIST/OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "B.C.O.",
"AuthorizedOfficialTelephoneNumber": "850-380-8184",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335E00000X",
"TaxonomyName": "Prosthetic/Orthotic Supplier",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}