{
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"OrgName": "WARNER ROBINS OPTICAL, INC.",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "212A CORDER RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WARNER ROBINS",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "31088-3604",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "478-929-2020",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "212A CORDER RD",
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"PracticeLocationAddressCityName": "WARNER ROBINS",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "478-929-2020",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/25/2007",
"LastUpdateDate": "07/25/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCREE",
"AuthorizedOfficialFirstName": "ADDISON",
"AuthorizedOfficialMiddleName": "BAILEY",
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "LDO",
"AuthorizedOfficialTelephoneNumber": "478-746-4866",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "LDO000695",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}