{
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"FirstLineMailingAddress": "8335 GRAND AVE",
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"MailingAddressCityName": "RIVER GROVE",
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"FirstLinePracticeLocationAddress": "8335 GRAND AVE",
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"EnumerationDate": "06/05/2017",
"LastUpdateDate": "06/05/2017",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOLDBERG",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "847-607-8189",
"Taxonomies": {
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"TaxonomyName": "Optician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X 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."
}
}
}
}