Unknown Individual – Optometrist, NPI 1396925749

Unknown Individual is a healthcare provider. based in Tucker, Georgia. specializing in Optometrist. They hold a License No. OPT809 (GA). The NPI Number for Unknown Individual is 1396925749

Main info

Organization
Inactive
50 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1396925749
Phone
(770) 934-0337
Address
2256 NORTHLAKE PKWY
Deactivation Date
8 May 2025

Doctor Profile

Medical School Name
UNIVERSITY ALABAMA BIRMINGHAM - SCHOOL OF OPTOMETRY
Secondary Phone
-
Graduation Year
1976 (50 years ago)
PAC ID
5890736086
Professional Enrollment ID
I20050518000478
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

  • 2256, Northlake Parkway, Tucker, DeKalb County, Georgia, 30084, United States

    SUITE #205

    TUCKER, GA 300844034

    Phone: (770) 934-0337

    Fax: (770) 939-5023

    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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
92014Established patient complete exam of visual system5050$0
99212Established patient office or other outpatient visit, 10-19 minutes3728$0
99214Established patient office or other outpatient visit, 30-39 minutes2120$0
92004New patient complete exam of visual system1212$0
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Insurance plans in this area (ZIP 30084)

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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 1396925749.
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's specialty?
The listing groups Unknown Individual with Optometrist. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Tucker, Georgia 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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