{
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"EIN": null,
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"OrgName": "COHOES EYE ASSOCIATES, LLC",
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"FirstName": null,
"MiddleName": null,
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"OtherLastName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "91 MOHAWK ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COHOES",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "12047",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "518-237-0342",
"MailingAddressFaxNumber": "518-235-9266",
"FirstLinePracticeLocationAddress": "91 MOHAWK ST",
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"PracticeLocationAddressCityName": "COHOES",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "12047-2809",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "518-237-0342",
"PracticeLocationAddressFaxNumber": "518-235-9266",
"EnumerationDate": "10/08/2017",
"LastUpdateDate": "09/24/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PRIMEAU",
"AuthorizedOfficialFirstName": "KELLY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OPTOMETRIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "518-233-0463",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": "TUV005872",
"LicenseNumberStateCode": "NY",
"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."
}
}
}
}