{"npi":"1073909354","type":"NPI-2","status":"active","name":{"display":"Geneseo Vision Center LLC","other":[],"organization_name":"GENESEO VISION CENTER LLC","authorised_official":"Ryan Wilson"},"specialty":{"primary_taxonomy":"152W00000X","primary_taxonomy_description":"Optometrist","slug":"optometrist","schema_org_specialty":null,"all":[{"code":"152W00000X","description":"Optometrist","primary":true,"state":"IL","license":"04600798"}]},"addresses":[{"purpose":"LOCATION","street_1":"112 S CENTER ST","city":"GENESEO","state":"IL","postal_code":"612541338","country_code":"US","phone":"3099445303","fax":"3099443465"},{"purpose":"MAILING","street_1":"112 S CENTER ST","city":"GENESEO","state":"IL","postal_code":"612541338","country_code":"US","phone":"3099445303","fax":"3099443465"}],"license":{"state":"IL","number":"04600798"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"046007958","state":"IL","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20150618001717","type_code":"12-70","type_desc":"PART B SUPPLIER - CLINIC/GROUP PRACTICE","state":"IL","pac_id":"1759692635"}]},"enumeration_date":"2015-04-13","last_updated":"2024-02-16","_meta":{"source":"NPPES","snapshot_date":"2024-02-16","doc_url":"https://findmynpi.com/api"}}