Unknown Individual – Optometrist, NPI 1104825900

Unknown Individual is a healthcare provider. based in Indianapolis, Indiana. specializing in Optometrist. They hold a License No. 18003120B (IN). The NPI Number for Unknown Individual is 1104825900

Main info

Organization
Inactive
25 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1104825900
Phone
(317) 899-1017
Address
1511 N POST RD
Deactivation Date
16 October 2024

Doctor Profile

Medical School Name
INDIANA UNIVERSITY - SCHOOL OF OPTOMETRY
Secondary Phone
3178991017
Graduation Year
2001 (25 years ago)
PAC ID
3779546775
Professional Enrollment ID
I20041110000874
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

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Provider Addresses for Unknown Individual

  • 1511, North Post Road, Washington Place, Indianapolis, Indiana, 46219, United States

    INDIANAPOLIS, IN 462194247

    Phone: (317) 899-1017

    Fax: (317) 899-1660

    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 1 Open Payments records for all available years, with a total value of $24.

Total Amount is formed as General ($24) + Research ($0) + Ownership ($0) = $24.

Last reported payment date: 2023-11-14 • Largest payer in this snapshot: Alcon Vision LLC ($24).

Total Amount

$24

General + Research + Ownership

Payments

1

Total payment records

General Amount

$24

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-11-14

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
Alcon Vision LLC$24
View all Open Payments →|Open Payments Risk Radar →

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 46219)

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Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1104825900 as the unique 10-digit identifier.
Can Unknown Individual still bill if the NPI is inactive?
Do not rely on inactive status alone — contact the provider for confirmation.
What expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Optometrist. Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on Indianapolis, Indiana.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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