{
"Npi": {
"NPI": "1750512414",
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "CONRAD FAULKNER OD PA",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
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"OtherLastName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "7395 US HIGHWAY 70 W",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LA GRANGE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28551-8211",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "252-566-4583",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "834 HARDEE RD",
"SecondLinePracticeLocationAddress": "VERNON PARK MALL",
"PracticeLocationAddressCityName": "KINSTON",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28504-3360",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "252-559-2020",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/29/2009",
"LastUpdateDate": "07/29/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FAULKNER",
"AuthorizedOfficialFirstName": "JAMES",
"AuthorizedOfficialMiddleName": "C",
"AuthorizedOfficialTitle": "OPTOMETRIST",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "252-566-4583",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "0758",
"LicenseNumberStateCode": "NC",
"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."
}
}
}
}