Unknown Individual – Optometrist, NPI 1457355935

Unknown Individual is a healthcare provider. based in Warner robins, Georgia. specializing in Optometrist. They hold a License No. OPT001271 (GA). The NPI Number for Unknown Individual is 1457355935

Main info

Organization
Inactive
45 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1457355935
Phone
(478) 923-5872
Address
216 CORDER RD
Deactivation Date
5 November 2021

Doctor Profile

Medical School Name
INDIANA UNIVERSITY - SCHOOL OF OPTOMETRY
Secondary Phone
4789711500
Graduation Year
1981 (45 years ago)
PAC ID
5799964094
Group Practice PAC ID
8224261201
Professional Enrollment ID
I20110119000267
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 216, Corder Road, Wrights Mill, Warner Robins, Houston County, Georgia, 31088, United States

    WARNER ROBINS, GA 310883604

    Phone: (478) 923-5872

    Fax: (478) 922-9020

    Type: Mailing

  • 3801, Northside Drive, McKibben Lane, Macon, Bibb County, Georgia, 31210, United States

    MACON, GA 312102418

    Phone: (478) 475-1600

    Fax: (478) 475-1876

    Type: Location

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.

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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 31088)

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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: 8224261201View full group profile

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1457355935 — is the standard way to identify this listing.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
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 Warner Robins, Georgia in our summary view.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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