{
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"FirstLineMailingAddress": "321 S HENDERSON ST",
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"MailingAddressCityName": "FORT WORTH",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76104-1016",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "817-529-9949",
"MailingAddressFaxNumber": "817-529-9943",
"FirstLinePracticeLocationAddress": "1509 W HEBRON PKWY",
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"PracticeLocationAddressTelephoneNumber": "214-390-7151",
"PracticeLocationAddressFaxNumber": "214-390-7152",
"EnumerationDate": "04/28/2017",
"LastUpdateDate": "04/28/2017",
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"NPIReactivationDate": null,
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"AuthorizedOfficialLastName": "PACKWOOD",
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"AuthorizedOfficialCredential": "MD",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Optometrist",
"LicenseNumber": "7210TG",
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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."
}
}
}
}