Unknown Individual – Optometrist, NPI 1669531455

Unknown Individual is a healthcare provider. based in Johnsburg, Illinois. specializing in Optometrist. They hold a License No. 304600953 (IL). The NPI Number for Unknown Individual is 1669531455

Main info

Organization
Inactive
55 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1669531455
Phone
(815) 385-0002
Address
3920 N. JOHNSBURG ROAD
Deactivation Date
26 October 2021

Doctor Profile

Medical School Name
ILLINOIS COLLEGE OF OPTOMETRY AT CHICAGO
Secondary Phone
8153850002
Graduation Year
1971 (55 years ago)
PAC ID
5092957563
Group Practice PAC ID
8426061169
Professional Enrollment ID
I20130813000232
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience18
Completeness75
Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 3920, North Johnsburg Road, Sunnyside, Johnsburg, McHenry County, Illinois, 60051, United States

    JOHNSBURG, IL 600516320

    Phone: (815) 385-0002

    Fax: (815) 385-0147

    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 60051)

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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: 8426061169View full group profile
NameSpecialtyState
O P T O M E T R YIL
O P T O M E T R YIL
O P T O M E T R YIL

Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1669531455?
NPI 1669531455 belongs to Unknown Individual; compare other details if you need extra assurance.
Can Unknown Individual still bill if the NPI is inactive?
Do not rely on inactive status alone — contact the provider for confirmation.
What clinical focus is listed for Unknown Individual?
At a glance, Unknown Individual is tied to Optometrist. Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Johnsburg?
Public fields place Unknown Individual around Johnsburg, Illinois. Always confirm the exact site before visiting.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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