{
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"FirstLineMailingAddress": "10220 WEST BROAD STREET",
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"MailingAddressCityName": "GLEN ALLEN",
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"MailingAddressFaxNumber": "804-527-5393",
"FirstLinePracticeLocationAddress": "10220 WEST BROAD STREET",
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"PracticeLocationAddressFaxNumber": "804-527-5393",
"EnumerationDate": "10/27/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WHITESIDE",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Optometrist",
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"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}