{
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"FirstLineMailingAddress": "250 N 18TH AVE STE 105",
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"MailingAddressCityName": "MONROE",
"MailingAddressStateName": "WI",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "250 N 18TH AVE STE 105",
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"EnumerationDate": "03/17/2015",
"LastUpdateDate": "09/16/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JOSEPHS",
"AuthorizedOfficialFirstName": "ANDREW",
"AuthorizedOfficialMiddleName": "M",
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"AuthorizedOfficialCredential": "O.D.",
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"Taxonomies": {
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"TaxonomyName": "Optometrist",
"LicenseNumber": "3082",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}