{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "GREAT LAKES EYE SURGERY CENTER LLC",
"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
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"Credential": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2393 SCHUST RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAGINAW",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48603-1334",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "989-793-2820",
"MailingAddressFaxNumber": "989-793-9132",
"FirstLinePracticeLocationAddress": "2393 SCHUST RD",
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"PracticeLocationAddressCityName": "SAGINAW",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "989-793-2820",
"PracticeLocationAddressFaxNumber": "989-793-9132",
"EnumerationDate": "01/07/2008",
"LastUpdateDate": "01/07/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHOKOOHI",
"AuthorizedOfficialFirstName": "FARHAD",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Ambulatory Surgical Clinic/Center",
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"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}