{
"Npi": {
"NPI": "1871849059",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PEND OREILLE VISION CARE",
"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": "514 OAK ST",
"SecondLineMailingAddress": "UNIT A",
"MailingAddressCityName": "SANDPOINT",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83864-1480",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-265-7965",
"MailingAddressFaxNumber": "208-265-7905",
"FirstLinePracticeLocationAddress": "514 OAK ST STE A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SANDPOINT",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83864-1480",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-265-7965",
"PracticeLocationAddressFaxNumber": "208-265-7905",
"EnumerationDate": "07/25/2012",
"LastUpdateDate": "03/09/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HARRELL",
"AuthorizedOfficialFirstName": "NATHANEAL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "208-265-7965",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}