Unknown Individual – Ophthalmology Physician, NPI 1114928082

Unknown Individual is a healthcare provider. based in Chula vista, California. specializing in Ophthalmology Physician. They hold a License No. C27512 (CA). The NPI Number for Unknown Individual is 1114928082

Main info

Organization
Inactive
62 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1114928082
Phone
(619) 427-3355
Address
480 4TH AVE
Deactivation Date
7 February 2024

Doctor Profile

Medical School Name
BAYLOR COLLEGE OF MEDICINE
Secondary Phone
6194273355
Graduation Year
1964 (62 years ago)
PAC ID
7315106440
Group Practice PAC ID
3971530122
Professional Enrollment ID
I20120329000173
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 480, 4th Avenue, Chula Vista, San Diego County, California, 91910, United States

    STE 201

    CHULA VISTA, CA 919104410

    Phone: (619) 427-3355

    Fax: (619) 427-0955

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 12 Open Payments records for all available years, with a total value of $293.

Total Amount is formed as General ($293) + Research ($0) + Ownership ($0) = $293.

Last reported payment date: 2023-11-08 • Largest payer in this snapshot: Alcon Vision LLC ($84).

Total Amount

$293

General + Research + Ownership

Payments

12

Total payment records

General Amount

$293

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-11-08

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
92250Photography of the retina123118$0
99213Established patient office or other outpatient visit, 20-29 minutes8869$0
92014Established patient complete exam of visual system6969$0
99214Established patient office or other outpatient visit, 30-39 minutes2120$0
92133Imaging of optic nerve1919$0
View full utilization report →

Insurance plans in this area (ZIP 91910)

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Provider's Procedures

Unknown Individual performs procedures in Ophthalmology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
OPHTHALMOLOGYCA92083Measurement of field of vision during daylight conditions235223
OPHTHALMOLOGYCA92134Diagnostic imaging of retina4845

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 3971530122View full group profile
NameSpecialtyState
O P H T H A L M O L O G YCA
-CA
O P H T H A L M O L O G YCA
O P H T H A L M O L O G YCA

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1114928082 — is the standard way to identify this listing.
Is Unknown Individual excluded from programs when inactive?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual's primary classification?
Ophthalmology Physician is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Chula Vista, California; more addresses can appear in NPPES.
Is the information about Unknown Individual up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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