{
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"FirstLineMailingAddress": "5316 S CHINOOK AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SIOUX FALLS",
"MailingAddressStateName": "SD",
"MailingAddressPostalCode": "57108-2588",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "605-380-5404",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "510 W EMPIRE MALL",
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"PracticeLocationAddressCityName": "SIOUX FALLS",
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"PracticeLocationAddressTelephoneNumber": "605-362-7944",
"PracticeLocationAddressFaxNumber": "605-362-7945",
"EnumerationDate": "12/11/2019",
"LastUpdateDate": "12/11/2019",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LORENZ",
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"AuthorizedOfficialTitle": "OPTOMETRIST",
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"AuthorizedOfficialCredential": "OD",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Optometrist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}