Unknown Individual – Optometrist, NPI 1083690408

Unknown Individual is a healthcare provider. based in Pueblo, Colorado. specializing in Optometrist. They hold a License No. 1565 (CO). The NPI Number for Unknown Individual is 1083690408

Main info

Organization
Inactive
34 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1083690408
Phone
(719) 404-5000
Address
1700 WEST ST # 50
Deactivation Date
9 January 2023

Doctor Profile

Medical School Name
SOUTHERN CALIFORNIA COLLEGE OF OPTOMETRY
Secondary Phone
-
Graduation Year
1992 (34 years ago)
PAC ID
3274681986
Professional Enrollment ID
I20090507000511
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

  • West Street, Northside, Pueblo, Pueblo County, Colorado, 81008, United States

    PUEBLO, CO 810032139

    Phone: (719) 404-5000

    Fax: (719) 404-1744

    Type: Mailing

  • South Santa Fe Avenue, Grove, Pueblo, Pueblo County, Colorado, 81003, United States

    PUEBLO, CO 810081614

    Phone: (719) 404-5000

    Fax: (719) 404-1744

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

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.

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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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 81003)

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Reviews

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Frequently asked questions

What identifier follows Unknown Individual across health systems?
The NPI 1083690408 uniquely identifies Unknown Individual in U.S. healthcare data.
Should I call the clinic if Unknown Individual is inactive here?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What services align with Unknown Individual's listing?
Unknown Individual's public classification highlights Optometrist. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to Pueblo, Colorado in registry-derived data.
What is the difference between NPI and a medical license?
An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.

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