Unknown Individual – Optometrist, NPI 1215986393

Unknown Individual is a healthcare provider. based in Jacksonville, Illinois. specializing in Optometrist. They hold a License No. 002574 (IA). The NPI Number for Unknown Individual is 1215986393

Main info

Organization
Inactive
28 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1215986393
Phone
(217) 245-8800
Address
1689 W MORTON AVE
Deactivation Date
22 August 2022

Doctor Profile

Medical School Name
UNIVERSITY OF MISSOURI ST LOUIS - SCHOOL OF OPTOMETRY
Secondary Phone
2172854000
Graduation Year
1998 (28 years ago)
PAC ID
8022049709
Group Practice PAC ID
0244125235
Professional Enrollment ID
I20050823000149
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience32
Completeness75
Years active:0State licenses:3Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 1689, West Morton Avenue, Jacksonville, Morgan County, Illinois, 62650, United States

    JACKSONVILLE, IL 626502717

    Phone: (217) 245-8800

    Fax: (217) 245-6100

    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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 62650)

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Provider's Procedures

Unknown Individual performs procedures in Optometrist. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
OPTOMETRYIL92012Eye and medical examination for diagnosis and treatment, established patient560289
OPTOMETRYIL92083Measurement of field of vision during daylight conditions165134
OPTOMETRYIL92134Diagnostic imaging of retina274197

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: 0244125235View full group profile
NameSpecialtyState
O P T O M E T R YMO
O P T O M E T R YIL
-MO
O P T O M E T R YIL
O P T O M E T R YNE
O P T O M E T R YIL
O P T O M E T R YIA
O P T O M E T R YIA
O P T O M E T R YIA
O P T O M E T R YMO

Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1215986393?
NPI 1215986393 belongs to Unknown Individual; compare other details if you need extra assurance.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Optometrist. Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Jacksonville?
Unknown Individual currently maps to Jacksonville, Illinois in this extract.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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