{
"Npi": {
"NPI": "1841621422",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MATTHEW C BOHRMAN OD LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3526 LAMAR AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHATTANOOGA",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "37415-4516",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "865-310-3087",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "309 N MARKET ST STE A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHATTANOOGA",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "37405-3908",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "865-310-3087",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/06/2013",
"LastUpdateDate": "12/06/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BOHRMAN",
"AuthorizedOfficialFirstName": "MATTHEW",
"AuthorizedOfficialMiddleName": "CHARLES",
"AuthorizedOfficialTitle": "OPTOMETRIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "865-310-3087",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "3029",
"LicenseNumberStateCode": "TN",
"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."
}
}
}
}