Unknown Individual – Optometrist, NPI 1336145572

Unknown Individual is a healthcare provider. based in Lawrenceville, Georgia. specializing in Optometrist. They hold a License No. 725T (GA). The NPI Number for Unknown Individual is 1336145572

Main info

Organization
Inactive
54 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1336145572
Phone
(770) 963-2903
Address
170 CAMDEN HILL RD
Deactivation Date
1 May 2024

Doctor Profile

Medical School Name
SOUTHERN COLLEGE OF OPTOMETRY
Secondary Phone
-
Graduation Year
1972 (54 years ago)
PAC ID
8527083708
Professional Enrollment ID
I20111109000583
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

  • 170, Camden Hill Road, Hanarry Estates, Lawrenceville, Gwinnett County, Georgia, 30046, United States

    STE B

    LAWRENCEVILLE, GA 300457418

    Phone: (770) 963-2903

    Fax: (770) 963-8387

    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 3 Open Payments records for all available years, with a total value of $207.

Total Amount is formed as General ($207) + Research ($0) + Ownership ($0) = $207.

Last reported payment date: 2023-10-22 • Largest payer in this snapshot: CooperVision Inc. ($102).

Total Amount

$207

General + Research + Ownership

Payments

3

Total payment records

General Amount

$207

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-10-22

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 system4847$0
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Insurance plans in this area (ZIP 30045)

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Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?
In the U.S., Unknown Individual is identified by NPI 1336145572.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
How should patients interpret Unknown Individual's specialty?
The extract shows Optometrist for Unknown Individual. Clinical services aligned with this taxonomy classification.
Is Unknown Individual tied to Lawrenceville, Georgia?
If you are local to Lawrenceville, Georgia, Unknown Individual may be relevant to your search.
Why is information missing for Unknown Individual?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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