{
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"FirstLineMailingAddress": "215 W 23RD ST",
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"MailingAddressStateName": "IL",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "312-526-3966",
"FirstLinePracticeLocationAddress": "215 W 23RD ST",
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"PracticeLocationAddressFaxNumber": "312-526-3966",
"EnumerationDate": "07/02/2017",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MEI",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "312-526-3331",
"Taxonomies": {
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"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}