Unknown Individual – Optometrist, NPI 1174550271

Unknown Individual is a healthcare provider. based in Burbank, Illinois. specializing in OPTOMETRY. They hold a License No. 046006386 (IL). The NPI Number for Unknown Individual is 1174550271

Main info

Organization
Inactive
57 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1174550271
Phone
(708) 636-3937
Address
5303 W 79TH ST
Deactivation Date
20 February 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1969 (57 years ago)
PAC ID
7113133562
Professional Enrollment ID
I20120501000148
Address ID
IL604591403Bu5303XSTXX400
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

1,715 OPTOMETRY in IL

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Provider Addresses for Unknown Individual

  • 79th Street, Burbank, Stickney Township, Cook County, Illinois, 60459, United States

    BURBANK, IL 604591403

    Phone: (708) 636-3937

    Fax: (708) 636-3997

    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 system2525$0
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Insurance plans in this area (ZIP 60459)

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Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1174550271 for Unknown Individual, then check state licensing separately.
Is Unknown Individual excluded from programs when inactive?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Optometrist. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Burbank, Illinois 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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