Unknown Individual – Optometrist, NPI 1528009586
Optometrist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
958 OPTOMETRY in GA
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Provider Addresses for Unknown Individual
128, North Park Drive, Fenwyck, Fayetteville, Fayette, Georgia, 30214, United States
FAYETTEVILLE, GA 302141645
Phone: (770) 461-3060
Fax: (770) 460-9348
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 8 Open Payments records for all available years, with a total value of $184.
Total Amount is formed as General ($184) + Research ($0) + Ownership ($0) = $184.
Last reported payment date: 2024-06-07 • Largest payer in this snapshot: CooperVision Inc. ($115).
Total Amount
$184
General + Research + Ownership
Payments
8
Total payment records
General Amount
$184
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-06-07
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| CooperVision Inc. | $115 |
| Alcon Vision LLC | $68 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20090219000215 | I | Optometry | GA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
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
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 92250 | Photography of the retina | 280 | 250 | $0 |
| 92012 | Established patient problem focused exam of visual system | 197 | 108 | $0 |
| 92014 | Established patient complete exam of visual system | 152 | 151 | $0 |
| 92083 | Exam of visual field with extended testing | 67 | 53 | $0 |
| 92133 | Imaging of optic nerve | 63 | 49 | $0 |
Insurance plans in this area (ZIP 30214)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| O P T O M E T R Y | GA | |
| O P T O M E T R Y | GA | |
| - | GA | |
| O P T O M E T R Y | GA | |
| O P T O M E T R Y | GA | |
| O P T O M E T R Y | GA | |
| O P T O M E T R Y | GA | |
| O P T O M E T R Y | GA | |
| - | GA | |
| O P T O M E T R Y | GA |
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