{
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"EIN": null,
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"OrgName": "AUDIE M TEAGUE O D P A",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
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"OtherLastName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 189",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PRESCOTT",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "71857-0189",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "870-887-3596",
"MailingAddressFaxNumber": "870-887-3945",
"FirstLinePracticeLocationAddress": "204 E 2ND SREET S",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PRESCOTT",
"PracticeLocationAddressStateName": "AR",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "870-887-3596",
"PracticeLocationAddressFaxNumber": "870-887-3945",
"EnumerationDate": "10/18/2006",
"LastUpdateDate": "08/14/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TEAGUE",
"AuthorizedOfficialFirstName": "AUDIE",
"AuthorizedOfficialMiddleName": "M.",
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "870-887-3596",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "2325",
"LicenseNumberStateCode": "AR",
"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."
}
}
}
}