{"npi":"1902858970","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":"332H00000X","description":"Eyewear Supplier","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"1306 N CENTRAL AVE","city":"MARSHFIELD","state":"WI","postal_code":"544491507","country_code":"US","phone":"7153878608"},{"purpose":"MAILING","street_1":"1306 N CENTRAL AVE","city":"MARSHFIELD","state":"WI","postal_code":"544491507","country_code":"US","phone":"7153878608"}],"license":null,"identifiers":[{"type_code":"01","label":"Other","value":"17640","state":null,"issuer":"MEDICARE"},{"type_code":"05","label":"Medicaid","value":"38416900","state":"WI","issuer":null},{"type_code":"01","label":"Other","value":"410985054-4009","state":null,"issuer":"NVA"},{"type_code":"01","label":"Other","value":"42566","state":null,"issuer":"DAVIS"},{"type_code":"01","label":"Other","value":"87831","state":null,"issuer":"MEDICARE"},{"type_code":"01","label":"Other","value":"014009","state":null,"issuer":"VIP"},{"type_code":"01","label":"Other","value":"CP2230-81","state":null,"issuer":"EYEMED"}],"pecos":{"enrolled_at":null,"enrollments":[]},"enumeration_date":"2006-05-17","last_updated":"2008-02-11","_meta":{"source":"NPPES","snapshot_date":"2008-02-11","doc_url":"https://findmynpi.com/api"}}