Unknown Individual – Optometrist, NPI 1184620114

Unknown Individual is a healthcare provider. based in Lawrenceville, Georgia. specializing in Optometrist. They hold a License No. 001383T (GA). The NPI Number for Unknown Individual is 1184620114

Main info

Organization
Inactive
33 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1184620114
Phone
(770) 513-3300
Address
725 WALTHER RD
Deactivation Date
26 June 2025

Doctor Profile

Medical School Name
SOUTHERN COLLEGE OF OPTOMETRY
Secondary Phone
7705133300
Graduation Year
1993 (33 years ago)
PAC ID
1456363589
Group Practice PAC ID
8628080751
Professional Enrollment ID
I20060608000030
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

  • Walther Road Northwest, Lawrenceville, Gwinnett County, Georgia, 30243, United States

    BUILDING 100

    LAWRENCEVILLE, GA 300458725

    Phone: (770) 513-3300

    Fax: (770) 513-3350

    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 4 Open Payments records for all available years, with a total value of $83.

Total Amount is formed as General ($83) + Research ($0) + Ownership ($0) = $83.

Last reported payment date: 2024-04-23 • Largest payer in this snapshot: CooperVision Inc. ($83).

Total Amount

$83

General + Research + Ownership

Payments

4

Total payment records

General Amount

$83

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-04-23

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
CooperVision Inc.$83
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
99214Established patient office or other outpatient visit, 30-39 minutes7065$0
99213Established patient office or other outpatient visit, 20-29 minutes4137$0
92250Photography of the retina1211$0
View full utilization report →

Insurance plans in this area (ZIP 30045)

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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
OPTOMETRYGA92083Measurement of field of vision during daylight conditions2718
OPTOMETRYGA92134Diagnostic imaging of retina1211

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: 8628080751View full group profile
NameSpecialtyState
-GA
O P T O M E T R YGA
O P T O M E T R YGA

Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1184620114 when you need to reference Unknown Individual in forms, claims, or directories.
Should I trust care from Unknown Individual if status is inactive?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
What kind of provider is Unknown Individual?
The page reflects Optometrist for Unknown Individual. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Georgia?
You will see Lawrenceville, Georgia on file for Unknown Individual alongside any extra practice locations.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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