{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "DR STANLEY DUSHMAN OD LTD",
"LastName": null,
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"NamePrefix": null,
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"Credential": null,
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"FirstLineMailingAddress": "1671 MISSON HILLS ROAD",
"SecondLineMailingAddress": "#302",
"MailingAddressCityName": "NORTH BROOK",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60062-5733",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "847-800-6691",
"MailingAddressFaxNumber": "847-272-1735",
"FirstLinePracticeLocationAddress": "1671 MISSON HILLS ROAD",
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"PracticeLocationAddressCityName": "NORTH BROOK",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "847-800-6691",
"PracticeLocationAddressFaxNumber": "847-272-1735",
"EnumerationDate": "09/25/2007",
"LastUpdateDate": "03/07/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": "08/13/2008",
"NPIReactivationDate": "11/10/2008",
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DUSHMAN",
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"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "847-800-6691",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "046005878",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}