{
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"FirstLineMailingAddress": "17025 NE 108TH WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "REDMOND",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98052-2794",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "18805 STATE ROUTE 2",
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"PracticeLocationAddressCityName": "MONROE",
"PracticeLocationAddressStateName": "WA",
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"PracticeLocationAddressFaxNumber": "360-805-0467",
"EnumerationDate": "06/24/2020",
"LastUpdateDate": "06/24/2020",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LEE",
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"AuthorizedOfficialMiddleName": "KEYJUNG",
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"AuthorizedOfficialCredential": "O.D.",
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"Taxonomies": {
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"TaxonomyName": "Optometrist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}