Unknown Individual – Ophthalmology Physician, NPI 1972567089

Unknown Individual is a healthcare provider. based in Fort walton beach, Florida. specializing in Ophthalmology Physician. They hold a License No. ME53982 (FL). The NPI Number for Unknown Individual is 1972567089

Main info

Organization
Inactive
49 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1972567089
Phone
(850) 862-4001
Address
1034 MAR WALT DR
Deactivation Date
9 October 2025

Doctor Profile

Medical School Name
UNIVERSITY OF TEXAS MEDICAL SCHOOL AT SAN ANTONIO
Secondary Phone
8508624001
Graduation Year
1977 (49 years ago)
PAC ID
2365347176
Group Practice PAC ID
7517862329
Professional Enrollment ID
I20101208000138
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

  • 1034, Mar Walt Drive, Wright, Fort Walton Beach, Okaloosa County, Florida, 32547, United States

    SUITE 200

    FORT WALTON BEACH, FL 325476645

    Phone: (850) 862-4001

    Fax: (850) 862-1612

    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 32547)

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Provider's Procedures

Unknown Individual performs procedures in Ophthalmology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
OPHTHALMOLOGYFL92012Eye and medical examination for diagnosis and treatment, established patient1362958
OPHTHALMOLOGYFL92083Measurement of field of vision during daylight conditions541515
OPHTHALMOLOGYFL92134Diagnostic imaging of retina137135

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: 7517862329View full group profile
NameSpecialtyState
O P H T H A L M O L O G YFL

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 1972567089.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Ophthalmology Physician. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Fort Walton Beach, Florida in our summary view.
Is the information about Unknown Individual up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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