{
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"IsOrgSubpart": "N",
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"OrgName": "PROFESSIONAL EYECARE GROUP, PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5746 WILLOW CREEK DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CANTON",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48187-3323",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "734-674-4736",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7555 TELEGRAPH RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TAYLOR",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48180-2239",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "313-292-7114",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/11/2013",
"LastUpdateDate": "12/05/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PATEL",
"AuthorizedOfficialFirstName": "VIMAL",
"AuthorizedOfficialMiddleName": "SURESHCHANDRA",
"AuthorizedOfficialTitle": "OPTOMETRIST",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "734-674-4736",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "4901004767",
"LicenseNumberStateCode": "MI",
"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."
}
}
}
}