{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "STELLAR VISION INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "358 S KOELLER ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OSHKOSH",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "54902-5546",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "920-233-0005",
"MailingAddressFaxNumber": "920-233-9097",
"FirstLinePracticeLocationAddress": "358 S KOELLER ST",
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"PracticeLocationAddressCityName": "OSHKOSH",
"PracticeLocationAddressStateName": "WI",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "920-233-0005",
"PracticeLocationAddressFaxNumber": "920-233-9097",
"EnumerationDate": "12/12/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SUNDSTROM",
"AuthorizedOfficialFirstName": "JEAN",
"AuthorizedOfficialMiddleName": "M.",
"AuthorizedOfficialTitle": "PRESIDENT OF CORPORATION",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "920-233-0005",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}