{
"Npi": {
"NPI": "1770511776",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KANSAS EYE SURGERY ASSOCIATES, P.C.",
"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": "24 CENTURY HILL DR",
"SecondLineMailingAddress": "SUITE 001",
"MailingAddressCityName": "LATHAM",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "12110-2133",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "518-690-2015",
"MailingAddressFaxNumber": "581-690-0353",
"FirstLinePracticeLocationAddress": "24 CENTURY HILL DR",
"SecondLinePracticeLocationAddress": "SUITE 001",
"PracticeLocationAddressCityName": "LATHAM",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "12110-2133",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "518-690-2015",
"PracticeLocationAddressFaxNumber": "581-690-0353",
"EnumerationDate": "06/29/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KWIAT",
"AuthorizedOfficialFirstName": "DAVIE",
"AuthorizedOfficialMiddleName": "MICHAEL",
"AuthorizedOfficialTitle": "PHYSICIAN",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "518-690-2015",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "174400000X",
"TaxonomyName": "Specialist",
"LicenseNumber": "226627",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}