{
"Npi": {
"NPI": "1003196783",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GONZALEZ",
"FirstName": "HEIDI",
"MiddleName": "MARIE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "O.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MAULDIN",
"OtherFirstName": "HEIDI",
"OtherMiddleName": "MARIE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "O.D.",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "470 TURQUOISE BCH DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SANTA ROSA BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32459-3061",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "334-791-0546",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4263 LEGENDARY DR",
"SecondLinePracticeLocationAddress": "STE J-105",
"PracticeLocationAddressCityName": "DESTIN",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32541-5392",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "850-389-6132",
"PracticeLocationAddressFaxNumber": "850-583-3632",
"EnumerationDate": "08/25/2011",
"LastUpdateDate": "08/24/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "OPC 4646",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}