Unknown Individual – Ophthalmology Physician, NPI 1730100033

Unknown Individual is a healthcare provider. based in Mchenry, Illinois. specializing in Ophthalmology Physician. They hold a License No. 22149 (WI). The NPI Number for Unknown Individual is 1730100033

Main info

Organization
Inactive
51 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1730100033
Phone
(815) 363-2020
Address
5400 W ELM ST
Deactivation Date
16 November 2022

Doctor Profile

Medical School Name
RUTGERS NEW JERSEY MEDICAL SCHOOL
Secondary Phone
-
Graduation Year
1975 (51 years ago)
PAC ID
2961488309
Professional Enrollment ID
I20041006000839
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

  • 5400, West Elm Street, Westside Crest Apartments, McHenry, McHenry County, Illinois, 60050, United States

    STE 120

    MCHENRY, IL 600504010

    Phone: (815) 363-2020

    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 60050)

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Provider's Procedures

Unknown Individual performs procedures in Ophthalmology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
OPHTHALMOLOGYIL92012Eye and medical examination for diagnosis and treatment, established patient357271

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?
In the U.S., Unknown Individual is identified by NPI 1730100033.
Should I call the clinic if Unknown Individual is inactive here?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What does the directory say Unknown Individual does?
Insurance directories may phrase it differently, but here Unknown Individual maps to Ophthalmology Physician. Clinical services aligned with this taxonomy classification.
What city is tied to Unknown Individual?
The directory associates Unknown Individual with Mchenry, Illinois. Check all listed addresses for suites or satellite offices.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.