Unknown Individual – Optometrist, NPI 1376526343

Unknown Individual is a healthcare provider. based in Demotte, Indiana. specializing in Optometrist. They hold a License No. 046008139 (IL). The NPI Number for Unknown Individual is 1376526343

Main info

Organization
Inactive
38 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1376526343
Phone
(219) 987-3673
Address
PO BOX 849
Deactivation Date
15 December 2020

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7084745700
Graduation Year
1988 (38 years ago)
PAC ID
7113956277
Group Practice PAC ID
2860421922
Professional Enrollment ID
I20120201000633
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

  • PO BOX 849

    DEMOTTE, IN 463100849

    Phone: (219) 987-3673

    Fax: (219) 987-3905

    Type: Mailing

  • 609, North Halleck Street, De Motte, Jasper County, Indiana, 46310, United States

    DEMOTTE, IN 463109545

    Phone: (219) 987-3673

    Fax: (219) 987-3905

    Type: Location

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 46310)

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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
OPTOMETRYIN92012Eye and medical examination for diagnosis and treatment, established patient379373

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: 2860421922View full group profile
NameSpecialtyState
O P T O M E T R YMD
O P T O M E T R YIN
O P T O M E T R YIN

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1376526343 — is the standard way to identify this listing.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What is Unknown Individual's primary classification?
Optometrist is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Demotte, Indiana in the data we show; additional addresses may exist on the full record.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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