{
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"IsOrgSubpart": "N",
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"OrgName": "DRS KELSO & KELSO OD PA",
"LastName": null,
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"NamePrefix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2205 W INDIANTOWN RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JUPITER",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33458-3924",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "561-743-2020",
"MailingAddressFaxNumber": "561-745-5409",
"FirstLinePracticeLocationAddress": "2205 W INDIANTOWN RD",
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"PracticeLocationAddressCityName": "JUPITER",
"PracticeLocationAddressStateName": "FL",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "561-743-2020",
"PracticeLocationAddressFaxNumber": "561-745-5409",
"EnumerationDate": "09/03/2008",
"LastUpdateDate": "03/09/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KELSO",
"AuthorizedOfficialFirstName": "TRAVIS",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "OPTOMETRIST",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "OPTOMETRIST",
"AuthorizedOfficialTelephoneNumber": "561-743-2020",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "OP3360",
"LicenseNumberStateCode": "FL",
"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."
}
}
}
}