{
  "npi": "1306983655",
  "enumeration_type": "NPI-2",
  "basic": {
    "authorized_official_credential": "OD",
    "authorized_official_first_name": "CHAD",
    "authorized_official_last_name": "ROBERTS",
    "authorized_official_middle_name": "LEWIS",
    "authorized_official_name_prefix": "Dr.",
    "authorized_official_name_suffix": "--",
    "authorized_official_telephone_number": "2087872088",
    "authorized_official_title_or_position": "Owner",
    "enumeration_date": "2007-01-30",
    "last_updated": "2007-10-10",
    "organization_name": "GRAND TETON EYE & OPTICAL",
    "organizational_subpart": "NO",
    "status": "A"
  },
  "addresses": [
    {
      "address_1": "PO BOX 613",
      "address_purpose": "MAILING",
      "address_type": "DOM",
      "city": "VICTOR",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "834550613",
      "state": "ID",
      "telephone_number": "208-787-2088"
    },
    {
      "address_1": "110 BUFFALO WAY STE A",
      "address_purpose": "LOCATION",
      "address_type": "DOM",
      "city": "JACKSON",
      "country_code": "US",
      "country_name": "United States",
      "postal_code": "830028460",
      "state": "WY",
      "telephone_number": "307-733-4905"
    }
  ],
  "taxonomies": [
    {
      "code": "152W00000X",
      "desc": "Optometrist",
      "license": "ODP-100010",
      "primary": true,
      "state": "ID",
      "taxonomy_group": "193400000X - Single Specialty Group"
    }
  ],
  "compliance": {
    "oig_leie_exclusion": {
      "excluded": false,
      "status": "CLEAR",
      "matches": [],
      "totalDbRecords": 84224
    },
    "cms_pecos_eligibility": {
      "note": "Not listed in CMS Order & Referring PECOS file or institutional NPI-2"
    }
  },
  "medicare_utilization": null,
  "enrichment": {
    "plain_english_specialty": "Licensed & Credentialed Eye and Vision Service Providers — Optometrist",
    "certifying_board": "State Medical / Healthcare Licensing Board & National Specialty Board",
    "cms_medicare_crosswalk": [
      {
        "medicare_code": "41",
        "medicare_type": "Optometry"
      }
    ]
  }
}