Unknown Individual – Optometrist, NPI 1104960384

Unknown Individual is a healthcare provider. based in Stratford, Connecticut. specializing in OPTOMETRY. They hold a License No. 1009 (CT). The NPI Number for Unknown Individual is 1104960384

Main info

Organization
Inactive
43 Years Of Experience
Name
Unknown Individual
NPI
1104960384
Phone
(203) 378-3113
Address
1040 BARNUM AVE
Deactivation Date
7 May 2026

Doctor Profile

Medical School Name
NEW ENGLAND COLLEGE OF OPTOMETRY
Secondary Phone
2033782269
Graduation Year
1983 (43 years ago)
PAC ID
0345370870
Group Practice PAC ID
3375673809
Professional Enrollment ID
I20100927001256
Address ID
CT066144861ST3333XSTXX301
Data current as of
3 June 2026

Profile Insights

NPPES metrics only — not quality of care.

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

530 OPTOMETRY in CT

Provider Addresses for Unknown Individual

  • 1040 BARNUM AVE

    STRATFORD, CT 066144968

    Phone: (203) 378-3113

    Fax: (203) 377-7207

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

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.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2010-09-27

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20100927001256IOptometryCTTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

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
92012Established patient problem focused exam of visual system5239$0
92014Established patient complete exam of visual system5150$0
92134Imaging of retina2722$0
View full utilization report →

Insurance plans in this area (ZIP 06614)

Loading plans...

Provider's Procedures

Unknown Individual performs procedures in OPTOMETRY. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
OPTOMETRYCT92012Eye and medical examination for diagnosis and treatment, established patient9359
OPTOMETRYCT92083Measurement of field of vision during daylight conditions1716
OPTOMETRYCT92134Diagnostic imaging of retina2925

Reviews

All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.

No reviews yet. Be the first to share your experience — your opinion helps families compare providers.

Frequently asked questions

Can I cross-check Unknown Individual using NPI 1104960384?
NPI 1104960384 belongs to Unknown Individual; compare other details if you need extra assurance.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What clinical focus is listed for Unknown Individual?
At a glance, Unknown Individual is tied to Optometrist. Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Stratford?
Public fields place Unknown Individual around Stratford, Connecticut. Always confirm the exact site before visiting.
Does Unknown Individual accept insurance?
Insurance participation is not part of the core NPI extract — call the plan or office to confirm.

Similar Providers

775, Main Street, Stratford, Fairfield County, Connecticut, 06615, United States
NPI: 1548256647
La Fortuna Bar & Restaurant, 7365, Main Street, Oronoque, Stratford, Fairfield County, Connecticut, 06614, United States
NPI: 1750338414
La Fortuna Bar & Restaurant, 7365, Main Street, Oronoque, Stratford, Fairfield County, Connecticut, 06614, United States
NPI: 1801834247
Walmart, 150, Barnum Avenue Cutoff, Stratford, Fairfield County, Connecticut, 06614, United States
NPI: 1225040132
775, Main Street, Stratford, Fairfield County, Connecticut, 06615, United States
NPI: 1114930419
DR THOMAS ENG
NPI: 1063518173
La Fortuna Bar & Restaurant, 7365, Main Street, Oronoque, Stratford, Fairfield County, Connecticut, 06614, United States
NPI: 1508955873
Joey C's Boathouse Cantina & Grill, 955, Ferry Boulevard, Stratford, Greater Bridgeport Planning Region, Connecticut, 06614, United States
NPI: 1316003775
1040 BARNUM AVE
NPI: 1548303928