{
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"LastName": null,
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"FirstLineMailingAddress": "54 MAIN ST STE 10",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAKEVILLE",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "02347-3622",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "800-853-8110",
"MailingAddressFaxNumber": "508-923-9894",
"FirstLinePracticeLocationAddress": "620 GEORGE WASHINGTON HWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LINCOLN",
"PracticeLocationAddressStateName": "RI",
"PracticeLocationAddressPostalCode": "02865-4293",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "401-642-0080",
"PracticeLocationAddressFaxNumber": "508-923-9894",
"EnumerationDate": "09/18/2015",
"LastUpdateDate": "08/13/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COHEN",
"AuthorizedOfficialFirstName": "LAWRENCE",
"AuthorizedOfficialMiddleName": "S",
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"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "508-699-5173",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "3586",
"LicenseNumberStateCode": "MA",
"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."
}
}
}
}