Unknown Individual – Optometrist, NPI 1053386573

Unknown Individual is a healthcare provider. based in Altamonte springs, Florida. specializing in Optometrist. They hold a License No. OPC1281 (FL). The NPI Number for Unknown Individual is 1053386573

Main info

Organization
Inactive
50 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1053386573
Phone
(407) 830-7442
Address
685 DOUGLAS AVE
Deactivation Date
25 October 2023

Doctor Profile

Medical School Name
ILLINOIS COLLEGE OF OPTOMETRY AT CHICAGO
Secondary Phone
3862523639
Graduation Year
1976 (50 years ago)
PAC ID
2264762350
Group Practice PAC ID
0941359533
Professional Enrollment ID
I20191003000862
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

  • 685, Douglas Avenue, Altamonte Springs, Seminole County, Florida, 32714, United States

    DOUGLAS SQUARE PROFESSIONAL CENTER

    ALTAMONTE SPRINGS, FL 327142555

    Phone: (407) 830-7442

    Fax: (407) 830-4665

    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 32714)

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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: 0941359533View full group profile

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1053386573.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What healthcare role does Unknown Individual hold?
Scheduling teams often label Unknown Individual under Optometrist. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Altamonte Springs, Florida in our summary view.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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