{
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"IsOrgSubpart": "N",
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"LastName": null,
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"NameSuffix": null,
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"FirstLineMailingAddress": "55 MAIN ST",
"SecondLineMailingAddress": "SUITE 1",
"MailingAddressCityName": "ESSEX JUNCTION",
"MailingAddressStateName": "VT",
"MailingAddressPostalCode": "05452-3191",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "802-879-0256",
"MailingAddressFaxNumber": "802-879-2401",
"FirstLinePracticeLocationAddress": "55 MAIN ST",
"SecondLinePracticeLocationAddress": "SUITE 1",
"PracticeLocationAddressCityName": "ESSEX JUNCTION",
"PracticeLocationAddressStateName": "VT",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "802-879-0256",
"PracticeLocationAddressFaxNumber": "802-879-2401",
"EnumerationDate": "02/05/2007",
"LastUpdateDate": "01/31/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ELLISON",
"AuthorizedOfficialFirstName": "JOHN",
"AuthorizedOfficialMiddleName": "W.",
"AuthorizedOfficialTitle": "MEMBER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "802-879-0256",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "030-0000316",
"LicenseNumberStateCode": "VT",
"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."
}
}
}
}