{
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"OrgName": "GEORGIA FAMILY EYECARE LLC",
"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "678 LAKE JOY RD.",
"SecondLineMailingAddress": "SUITE B",
"MailingAddressCityName": "KATHLEEN",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31047",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "407-749-8670",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1012 HIGHWAY 96",
"SecondLinePracticeLocationAddress": "STE 300",
"PracticeLocationAddressCityName": "WARNER ROBINS",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "31088",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "407-749-8670",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/28/2016",
"LastUpdateDate": "12/30/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KHOSHOOEE",
"AuthorizedOfficialFirstName": "NAVID",
"AuthorizedOfficialMiddleName": "REZA",
"AuthorizedOfficialTitle": "OPTOMETRIST / OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "407-749-8670",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "OPT002845",
"LicenseNumberStateCode": "GA",
"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."
}
}
}
}