{
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"LastName": null,
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"FirstLineMailingAddress": "1705 DELHI ST UPPR LEVEL",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DUBUQUE",
"MailingAddressStateName": "IA",
"MailingAddressPostalCode": "52001-5900",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "563-557-1010",
"MailingAddressFaxNumber": "563-557-1073",
"FirstLinePracticeLocationAddress": "1705 DELHI ST UPPR LEVEL",
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"PracticeLocationAddressCityName": "DUBUQUE",
"PracticeLocationAddressStateName": "IA",
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"PracticeLocationAddressTelephoneNumber": "563-557-1010",
"PracticeLocationAddressFaxNumber": "563-557-1073",
"EnumerationDate": "07/10/2018",
"LastUpdateDate": "03/17/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KLAUER",
"AuthorizedOfficialFirstName": "JOSEPH",
"AuthorizedOfficialMiddleName": "DONALD",
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "563-557-1010",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Optometrist",
"LicenseNumber": "092709",
"LicenseNumberStateCode": "IA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}