{
"Npi": {
"NPI": "1841314846",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JERSEY FAMILY VISION CARE, LTD",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1600 S STATE ST",
"SecondLineMailingAddress": "SUITE I",
"MailingAddressCityName": "JERSEYVILLE",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "62052-3620",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "618-498-7581",
"MailingAddressFaxNumber": "618-498-7586",
"FirstLinePracticeLocationAddress": "1600 S STATE ST",
"SecondLinePracticeLocationAddress": "SUITE I",
"PracticeLocationAddressCityName": "JERSEYVILLE",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "62052-3620",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "618-498-7581",
"PracticeLocationAddressFaxNumber": "618-498-7586",
"EnumerationDate": "03/17/2007",
"LastUpdateDate": "03/11/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STEINHAUER",
"AuthorizedOfficialFirstName": "JULIE",
"AuthorizedOfficialMiddleName": "ANN",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OD, FCOVD",
"AuthorizedOfficialTelephoneNumber": "618-498-7581",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "152WV0400X",
"TaxonomyName": "Vision Therapy Optometrist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}