{
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"OrgName": "MANCHESTER BRICK VISION CENTER",
"LastName": null,
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"FirstLineMailingAddress": "359 BRICK BLVD",
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"MailingAddressCityName": "BRICK",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "08723-6010",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "732-920-1330",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "359 BRICK BLVD",
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"PracticeLocationAddressCityName": "BRICK",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "732-920-1330",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/24/2007",
"LastUpdateDate": "01/16/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SMITH",
"AuthorizedOfficialFirstName": "MARIE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MS.",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "732-920-1330",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Optometrist",
"LicenseNumber": "NJ5293",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
}
}
}