{
"Npi": {
"NPI": "1962674606",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WAYNE GOLDEN OD PA",
"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": "5045 FRUITVILLE RD STE 123",
"SecondLineMailingAddress": "GOLDEN VISION",
"MailingAddressCityName": "SARASOTA",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34232-2269",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "941-342-9711",
"MailingAddressFaxNumber": "941-378-3011",
"FirstLinePracticeLocationAddress": "5045 FRUITVILLE RD STE 123",
"SecondLinePracticeLocationAddress": "GOLDEN VISION",
"PracticeLocationAddressCityName": "SARASOTA",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34232-2269",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "941-342-9711",
"PracticeLocationAddressFaxNumber": "941-378-3011",
"EnumerationDate": "04/01/2008",
"LastUpdateDate": "05/25/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOLDEN",
"AuthorizedOfficialFirstName": "WAYNE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OPTOMETRIC PHYSICIAN",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "941-342-9711",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "OPC2764",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}