Unknown Individual – Optometrist, NPI 1821359274

Unknown Individual is a healthcare provider. based in Lake city, Florida. specializing in Optometrist. They hold a License No. OPC4719 (FL). The NPI Number for Unknown Individual is 1821359274

Main info

Organization
Inactive
14 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1821359274
Phone
(386) 752-1722
Address
763 SW MAIN BLVD
Deactivation Date
17 April 2024

Doctor Profile

Medical School Name
NOVA SOUTHEASTERN COLLEGE OF OSTEO MEDICINE
Secondary Phone
3867521722
Graduation Year
2012 (14 years ago)
PAC ID
9739336421
Group Practice PAC ID
5294853313
Professional Enrollment ID
I20120831000449
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

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

Provider Addresses for Unknown Individual

  • 763 SW MAIN BLVD

    LAKE CITY, FL 320255791

    Phone: (386) 752-1722

    Fax: (386) 752-1157

    Type: Mailing

  • 4101 EVANS AVE

    FORT MYERS, FL 33901

    Phone: (239) 939-3456

    Fax: (239) 790-2432

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 7 Open Payments records for all available years, with a total value of $204.

Total Amount is formed as General ($204) + Research ($0) + Ownership ($0) = $204.

Last reported payment date: 2024-02-06 • Largest payer in this snapshot: Johnson & Johnson Vision Care, Inc. ($113).

Total Amount

$204

General + Research + Ownership

Payments

7

Total payment records

General Amount

$204

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-02-06

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 system223221$0
99213Established patient office or other outpatient visit, 20-29 minutes158105$0
92133Imaging of optic nerve3125$0
92082Exam of visual field with intermediate testing3023$0
99214Established patient office or other outpatient visit, 30-39 minutes2622$0
View full utilization report →

Insurance plans in this area (ZIP 32025)

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Provider's Procedures

Unknown Individual performs procedures in Optometrist. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
OPTOMETRYFL92012Eye and medical examination for diagnosis and treatment, established patient3932

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: 5294853313View full group profile
NameSpecialtyState
-FL

Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1821359274?
NPI 1821359274 belongs to Unknown Individual; compare other details if you need extra assurance.
Can Unknown Individual still bill if the NPI is inactive?
Do not rely on inactive status alone — contact the provider for confirmation.
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 located near Lake City?
Unknown Individual currently maps to Lake City, Florida in this extract.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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