{
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"FirstLineMailingAddress": "222 N G ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN BERNARDINO",
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"MailingAddressPostalCode": "92410-3269",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-885-1134",
"MailingAddressFaxNumber": "909-888-2349",
"FirstLinePracticeLocationAddress": "222 N G ST",
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"PracticeLocationAddressCityName": "SAN BERNARDINO",
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"PracticeLocationAddressTelephoneNumber": "909-885-1134",
"PracticeLocationAddressFaxNumber": "909-888-2349",
"EnumerationDate": "12/02/2010",
"LastUpdateDate": "01/05/2012",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MORTON",
"AuthorizedOfficialFirstName": "MICHAEL",
"AuthorizedOfficialMiddleName": "KEVIN",
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"AuthorizedOfficialCredential": "O.D.",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Optometrist",
"LicenseNumber": "13533TLG",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}