{
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"EIN": null,
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"OrgName": "OPTOMETRIC EYE CARE ASSOCIATES",
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"FirstName": null,
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"NamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "10327 REGENCY STATION DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FAIRFAX STATION",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22039-1852",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5765 BURKE CENTRE PKWY STE L",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BURKE",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "22015-2264",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "703-250-2000",
"PracticeLocationAddressFaxNumber": "703-978-9581",
"EnumerationDate": "03/21/2007",
"LastUpdateDate": "06/21/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KATZ",
"AuthorizedOfficialFirstName": "RICHARD",
"AuthorizedOfficialMiddleName": "SAUL",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "703-250-2000",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "0618000071",
"LicenseNumberStateCode": "VA",
"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."
}
}
}
}