{
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"FirstLineMailingAddress": "1300 S EASTERN AVE",
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"MailingAddressCityName": "LAS VEGAS",
"MailingAddressStateName": "NV",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "702-385-2242",
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"EnumerationDate": "04/10/2007",
"LastUpdateDate": "10/04/2011",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ANGELL",
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"AuthorizedOfficialMiddleName": "CHARLES",
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"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "702-385-2242",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Optometrist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}