{
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"FirstLineMailingAddress": "91-12A ATLANTIC AVENUE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OZONE PARK",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11416",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-845-3737",
"MailingAddressFaxNumber": "718-641-8461",
"FirstLinePracticeLocationAddress": "91-12A ATLANTIC AVENUE",
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"PracticeLocationAddressCityName": "OZONE PARK",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-845-3737",
"PracticeLocationAddressFaxNumber": "718-641-8461",
"EnumerationDate": "06/29/2006",
"LastUpdateDate": "11/20/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VASSERMAN",
"AuthorizedOfficialFirstName": "TSYLYA",
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"AuthorizedOfficialCredential": "OPTICIAN",
"AuthorizedOfficialTelephoneNumber": "718-845-3737",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "00267456",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}