{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "LIGHTS PROSTHETIC EYES INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
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"FirstLineMailingAddress": "1318 W CANDLETREE DR",
"SecondLineMailingAddress": "SUITE 3",
"MailingAddressCityName": "PEORIA",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "61614-8508",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "309-676-3663",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1736 E SUNSHINE ST",
"SecondLinePracticeLocationAddress": "SUITE 404",
"PracticeLocationAddressCityName": "SPRINGFIELD",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "65804-1343",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "417-889-0988",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/03/2008",
"LastUpdateDate": "07/09/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LIGHT",
"AuthorizedOfficialFirstName": "RANDY",
"AuthorizedOfficialMiddleName": "L",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
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"AuthorizedOfficialCredential": "BCO",
"AuthorizedOfficialTelephoneNumber": "309-676-3663",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "156FX1700X",
"TaxonomyName": "Ocularist",
"LicenseNumber": "17065569",
"LicenseNumberStateCode": "MO",
"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."
}
}
}
}