{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COREN EYE GROUP PLLC",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
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"FirstLineMailingAddress": "4137 BRIAR GATE LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WINTER GARDEN",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34787-5521",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "407-256-3763",
"MailingAddressFaxNumber": "407-386-7664",
"FirstLinePracticeLocationAddress": "112 E DIXIE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LEESBURG",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34748-6350",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "352-787-1956",
"PracticeLocationAddressFaxNumber": "352-365-6690",
"EnumerationDate": "08/30/2017",
"LastUpdateDate": "12/06/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TRAN",
"AuthorizedOfficialFirstName": "ANDREW",
"AuthorizedOfficialMiddleName": "VU",
"AuthorizedOfficialTitle": "AUTHORIZED MEMBER",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "407-256-3763",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "4108",
"LicenseNumberStateCode": "FL",
"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."
}
}
}
}