{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "OM VISION SERVICES INC,",
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"MiddleName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2300 BERNADETTE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COLUMBIA",
"MailingAddressStateName": "MO",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "417-881-5530",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2300 BERNADETTE DR",
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"PracticeLocationAddressCityName": "COLUMBIA",
"PracticeLocationAddressStateName": "MO",
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"PracticeLocationAddressTelephoneNumber": "417-881-5530",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/16/2015",
"LastUpdateDate": "05/27/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CROSS",
"AuthorizedOfficialFirstName": "LAURA",
"AuthorizedOfficialMiddleName": "LEANN",
"AuthorizedOfficialTitle": "REG MANAGER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "417-881-5530",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "156FX1800X",
"TaxonomyName": "Optician",
"LicenseNumber": "17822",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261Q00000X",
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}