{
"Npi": {
"NPI": "1568700714",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "IDONI",
"FirstName": "JENNIFER",
"MiddleName": "D",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "OD, FAAO, FCOVD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "8614 WESTWOOD CENTER DR FL 9",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "VIENNA",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22182-2442",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "703-847-8899",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5330 SOUTH BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHARLOTTE",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28217-4116",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "704-525-9802",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/23/2013",
"LastUpdateDate": "05/20/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "152WP0200X",
"TaxonomyName": "Pediatric Optometrist",
"LicenseNumber": "2507",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "2507",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}