{
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"EIN": null,
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"OrgName": "JUDISCH VISION PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"FirstLineMailingAddress": "PO BOX 80",
"SecondLineMailingAddress": "1160 3RD ST",
"MailingAddressCityName": "LAKE VIEW",
"MailingAddressStateName": "IA",
"MailingAddressPostalCode": "51450-0080",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "712-657-3304",
"MailingAddressFaxNumber": "712-657-3303",
"FirstLinePracticeLocationAddress": "1160 3RD ST",
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"PracticeLocationAddressCityName": "LAKE VIEW",
"PracticeLocationAddressStateName": "IA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "712-657-3304",
"PracticeLocationAddressFaxNumber": "712-657-3303",
"EnumerationDate": "01/24/2007",
"LastUpdateDate": "05/07/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JUDISCH",
"AuthorizedOfficialFirstName": "JONATHAN",
"AuthorizedOfficialMiddleName": "PAUL",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "712-657-3304",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "02262",
"LicenseNumberStateCode": "IA",
"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."
}
}
}
}