{
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"FirstLineMailingAddress": "16 OLD RIVERHEAD RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WESTHAMPTON BEACH",
"MailingAddressStateName": "NY",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-898-5000",
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"FirstLinePracticeLocationAddress": "16 OLD RIVERHEAD RD",
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"EnumerationDate": "03/21/2025",
"LastUpdateDate": "04/23/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WAGONER",
"AuthorizedOfficialFirstName": "PETER",
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"AuthorizedOfficialTitle": "OPTOMETRIST",
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"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}