Unknown Individual – Optometrist, NPI 1124002696

Unknown Individual is a healthcare provider. based in Palm springs, Florida. specializing in Optometrist. They hold a License No. OPC1251 (FL). The NPI Number for Unknown Individual is 1124002696

Main info

Organization
Inactive
51 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1124002696
Phone
(561) 967-4355
Address
3015 S CONGRESS AVE
Deactivation Date
21 June 2023

Doctor Profile

Medical School Name
SOUTHERN CALIFORNIA COLLEGE OF OPTOMETRY
Secondary Phone
5619674355
Graduation Year
1975 (51 years ago)
PAC ID
0941371702
Group Practice PAC ID
0648561712
Professional Enrollment ID
I20080623000122
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

  • 3015, South Congress Avenue, Palm Springs, Palm Beach County, Florida, 33461, United States

    STE 9

    PALM SPRINGS, FL 334612111

    Phone: (561) 967-4355

    Fax: (561) 967-4466

    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 1 Open Payments records for all available years, with a total value of $164.

Total Amount is formed as General ($164) + Research ($0) + Ownership ($0) = $164.

Last reported payment date: 2023-04-01 • Largest payer in this snapshot: Bausch & Lomb Americas Inc. ($164).

Total Amount

$164

General + Research + Ownership

Payments

1

Total payment records

General Amount

$164

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-04-01

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
92014Established patient complete exam of visual system3131$0
View full utilization report →

Insurance plans in this area (ZIP 33461)

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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: 0648561712View full group profile
NameSpecialtyState
O P T O M E T R YFL
O P T O M E T R YFL

Reviews

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Frequently asked questions

What is Unknown Individual's NPI number?
Unknown Individual's NPI is 1124002696 — the number used across U.S. healthcare to identify this provider.
Can Unknown Individual still bill if the NPI is inactive?
Do not rely on inactive status alone — contact the provider for confirmation.
What area of care is associated with Unknown Individual?
Unknown Individual's record emphasizes Optometrist. Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on Palm Springs, Florida.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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