Unknown Individual – Ophthalmology Physician, NPI 1205833878

Unknown Individual is a healthcare provider. based in Manchester, Connecticut. specializing in Ophthalmology Physician. They hold a License No. 028936 (CT). The NPI Number for Unknown Individual is 1205833878

Main info

Organization
Inactive
50 Years Of Experience
Name
Unknown Individual
NPI
1205833878
Phone
(860) 646-7704
Address
191 MAIN ST
Deactivation Date
13 February 2025

Doctor Profile

Medical School Name
UNIVERSITY OF MISSOURI, COLUMBIA SCHOOL OF MEDICINE
Secondary Phone
8605279020
Graduation Year
1976 (50 years ago)
PAC ID
3779541107
Group Practice PAC ID
5799875951
Professional Enrollment ID
I20041230000602

Contacts

Secure Messaging
apacker@retinact.intellechartdirect.net
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

  • 191, Main Street, Manchester, Hillsborough County, New Hampshire, 03102, United States

    MANCHESTER, CT 060423556

    Phone: (860) 646-7704

    Fax: (860) 647-7340

    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)

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.

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.

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

Insurance plans in this area (ZIP 06042)

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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: 5799875951View full group profile
NameSpecialtyState
O P H T H A L M O L O G YCT
O P H T H A L M O L O G YCT
-CT
-CT
O P H T H A L M O L O G YCT
O P H T H A L M O L O G YCT
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 YCT
-CT

Reviews

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Frequently asked questions

Can I use this page to confirm Unknown Individual's NPI?
Yes. Unknown Individual is listed with NPI 1205833878 in the public NPI dataset.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Ophthalmology Physician. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Manchester, Connecticut may find Unknown Individual in results; validate coverage separately.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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