{
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"FirstLineMailingAddress": "285 W 74TH PL",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HIALEAH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33014-5058",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5201 RAYMOND ST RM 1209B",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ORLANDO",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "407-599-1566",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/06/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MARTIN",
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"AuthorizedOfficialTelephoneNumber": "305-557-9004",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "DO 5220",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}