{
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"IsOrgSubpart": "Y",
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"FirstName": null,
"MiddleName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3333 US ROUTE 60",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HUNTINGTON",
"MailingAddressStateName": "WV",
"MailingAddressPostalCode": "25705",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "304-522-2551",
"MailingAddressFaxNumber": "304-522-2544",
"FirstLinePracticeLocationAddress": "3333 US ROUTE 60",
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"PracticeLocationAddressCityName": "HUNTINGTON",
"PracticeLocationAddressStateName": "WV",
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"PracticeLocationAddressTelephoneNumber": "304-522-2551",
"PracticeLocationAddressFaxNumber": "304-522-2544",
"EnumerationDate": "09/06/2007",
"LastUpdateDate": "07/25/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BROWN",
"AuthorizedOfficialFirstName": "MARK",
"AuthorizedOfficialMiddleName": "CHARLES",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "304-522-2551",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "WV 740 D",
"LicenseNumberStateCode": "WV",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
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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."
}
}
}
}