{
"Npi": {
"NPI": "1851706618",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SAB HOLDINGS 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": "400 N SECOND ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GALLUP",
"MailingAddressStateName": "NM",
"MailingAddressPostalCode": "87301-5227",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "505-565-7754",
"MailingAddressFaxNumber": "505-488-2687",
"FirstLinePracticeLocationAddress": "400 N SECOND ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GALLUP",
"PracticeLocationAddressStateName": "NM",
"PracticeLocationAddressPostalCode": "87301-5227",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "505-565-7754",
"PracticeLocationAddressFaxNumber": "505-488-2687",
"EnumerationDate": "06/30/2014",
"LastUpdateDate": "06/30/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BHAKTA",
"AuthorizedOfficialFirstName": "URVASHI",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "505-870-3212",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "03-295268-006",
"LicenseNumberStateCode": "NM",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}