{
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"EIN": null,
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"OrgName": "PR EYECARE CONSULTING GROUP OD PA",
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"FirstLineMailingAddress": "12910 SHELBYVILLE RD STE 300",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LOUISVILLE",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "40243-2404",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "502-244-2441",
"MailingAddressFaxNumber": "502-996-8282",
"FirstLinePracticeLocationAddress": "1040 RANDOLPH STR",
"SecondLinePracticeLocationAddress": "STE 14-15",
"PracticeLocationAddressCityName": "THOMASVILLE",
"PracticeLocationAddressStateName": "NC",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "336-472-8700",
"PracticeLocationAddressFaxNumber": "336-472-8740",
"EnumerationDate": "07/06/2006",
"LastUpdateDate": "10/25/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROGASKI",
"AuthorizedOfficialFirstName": "PETER",
"AuthorizedOfficialMiddleName": "MICHAEL",
"AuthorizedOfficialTitle": "PRESIDENT OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "336-472-8700",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "152W00000X",
"TaxonomyName": "Optometrist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}