{
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"FirstLineMailingAddress": "9349 MISSION GORGE RD",
"SecondLineMailingAddress": "#114",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "9349 MISSION GORGE RD",
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"PracticeLocationAddressTelephoneNumber": "858-405-9484",
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"EnumerationDate": "04/30/2009",
"LastUpdateDate": "09/01/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GENDELMAN PATEL",
"AuthorizedOfficialFirstName": "IRENE",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "O,D,",
"AuthorizedOfficialTelephoneNumber": "858-405-9584",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "13305 T",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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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."
}
}
}
}