{
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"IsOrgSubpart": "N",
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"NameSuffix": null,
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"FirstLineMailingAddress": "1001 E. SUNSET ROAD",
"SecondLineMailingAddress": "UNIT 96595",
"MailingAddressCityName": "LAS VEGAS",
"MailingAddressStateName": "NV",
"MailingAddressPostalCode": "89193-1246",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "702-798-0113",
"MailingAddressFaxNumber": "866-291-5242",
"FirstLinePracticeLocationAddress": "3373 PRINCETON RD",
"SecondLinePracticeLocationAddress": "SUITE D117",
"PracticeLocationAddressCityName": "HAMILTON",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "45011-5416",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "513-895-4327",
"PracticeLocationAddressFaxNumber": "513-894-4327",
"EnumerationDate": "07/24/2015",
"LastUpdateDate": "09/08/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GLEN",
"AuthorizedOfficialFirstName": "CHRISTOPHER",
"AuthorizedOfficialMiddleName": "A",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "HAS",
"AuthorizedOfficialTelephoneNumber": "513-895-4327",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "237600000X",
"TaxonomyName": "Audiologist-Hearing Aid Fitter",
"LicenseNumber": "03273",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "N"
},
{
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},
{
"TaxonomyCode": "332S00000X",
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"LicenseNumber": "03273",
"LicenseNumberStateCode": "OH",
"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."
},
{
"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."
}
]
}
}
}