{
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"EIN": null,
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"IsOrgSubpart": "N",
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"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": "6",
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5306 CORTEZ RD W",
"SecondLineMailingAddress": "STE 3",
"MailingAddressCityName": "BRADENTON",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34210-2821",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "941-794-1333",
"MailingAddressFaxNumber": "941-794-5640",
"FirstLinePracticeLocationAddress": "5306 CORTEZ RD W",
"SecondLinePracticeLocationAddress": "STE 3",
"PracticeLocationAddressCityName": "BRADENTON",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "941-794-1333",
"PracticeLocationAddressFaxNumber": "941-794-5640",
"EnumerationDate": "08/24/2006",
"LastUpdateDate": "10/22/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CRUMP",
"AuthorizedOfficialFirstName": "PARNELL",
"AuthorizedOfficialMiddleName": "JAY",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "941-794-1333",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "OPC 2343",
"LicenseNumberStateCode": "FL",
"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."
}
}
}
}