{
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"EIN": null,
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"FirstLineMailingAddress": "120 MAIN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JOHNSTOWN",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "15901-1507",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "814-536-5343",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "215 GEORGIAN PL",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SOMERSET",
"PracticeLocationAddressStateName": "PA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "814-445-3730",
"PracticeLocationAddressFaxNumber": "814-445-5496",
"EnumerationDate": "04/03/2017",
"LastUpdateDate": "04/04/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "POLITO",
"AuthorizedOfficialFirstName": "JOSEPH",
"AuthorizedOfficialMiddleName": "R",
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"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "814-536-5343",
"Taxonomies": {
"Taxonomy": {
"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."
}
}
}
}