{
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"EIN": null,
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"FirstLineMailingAddress": "409 QUAIL MEADOWS LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ARLINGTON",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76002-3475",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "972-274-6600",
"MailingAddressFaxNumber": "972-274-6603",
"FirstLinePracticeLocationAddress": "951 W BELT LINE RD",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "DESOTO",
"PracticeLocationAddressStateName": "TX",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "972-274-6600",
"PracticeLocationAddressFaxNumber": "972-274-6603",
"EnumerationDate": "05/01/2009",
"LastUpdateDate": "07/02/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PHAN",
"AuthorizedOfficialFirstName": "LY",
"AuthorizedOfficialMiddleName": "KHAC",
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "972-274-6600",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Optometrist",
"LicenseNumber": "0798TG",
"LicenseNumberStateCode": "TX",
"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."
}
}
}
}