{"npi":"1609828136","type":"NPI-2","status":"active","name":{"display":"Shopko Stores Operating Co. LLC","other":[],"organization_name":"SHOPKO STORES OPERATING CO. LLC","authorised_official":"Michael Bettiga"},"specialty":{"primary_taxonomy":"332H00000X","primary_taxonomy_description":"Eyewear Supplier","slug":"eyewear-supplier","schema_org_specialty":null,"all":[{"code":"152W00000X","description":"Optometrist","primary":false,"state":null,"license":null},{"code":"156FX1800X","description":"Optician","primary":false,"state":null,"license":null},{"code":"332H00000X","description":"Eyewear Supplier","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"1341 N MAIN ST","city":"LOGAN","state":"UT","postal_code":"843412221","country_code":"US","phone":"4357530700"},{"purpose":"MAILING","street_1":"1341 N MAIN ST","city":"LOGAN","state":"UT","postal_code":"843412221","country_code":"US","phone":"4357530700"}],"license":null,"identifiers":[{"type_code":"01","label":"Other","value":"35721","state":null,"issuer":"AVESIS"},{"type_code":"01","label":"Other","value":"014091","state":null,"issuer":"VIP"},{"type_code":"05","label":"Medicaid","value":"410985054-148","state":"UT","issuer":null},{"type_code":"01","label":"Other","value":"CP2230-43","state":null,"issuer":"EYEMED"},{"type_code":"01","label":"Other","value":"17924","state":null,"issuer":"MEDICARE"},{"type_code":"01","label":"Other","value":"UT04878","state":"UT","issuer":"NORIDIAN SUBMITTER ID"},{"type_code":"01","label":"Other","value":"42567","state":null,"issuer":"DAVIS"}],"pecos":{"enrolled_at":null,"enrollments":[]},"enumeration_date":"2006-05-16","last_updated":"2008-07-10","_meta":{"source":"NPPES","snapshot_date":"2008-07-10","doc_url":"https://findmynpi.com/api"}}