{
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"NamePrefix": null,
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"FirstLineMailingAddress": "300 A AVE",
"SecondLineMailingAddress": "BLDG 1605",
"MailingAddressCityName": "FORT LEE",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23801-1520",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "479-841-5902",
"MailingAddressFaxNumber": "804-732-0516",
"FirstLinePracticeLocationAddress": "300 A AVENUE",
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"PracticeLocationAddressCityName": "FORT LEE",
"PracticeLocationAddressStateName": "VA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "256-737-9109",
"PracticeLocationAddressFaxNumber": "804-732-0516",
"EnumerationDate": "12/14/2009",
"LastUpdateDate": "10/01/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DANIEL",
"AuthorizedOfficialFirstName": "LANCE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "O.D.",
"AuthorizedOfficialTelephoneNumber": "804-733-8274",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Optometrist",
"LicenseNumber": "0618001611",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}