Unknown Individual – Optometrist, NPI 1902896640

Unknown Individual is a healthcare provider. based in Glasgow, Kentucky. specializing in Optometrist. They hold a License No. 1209DT (KY). The NPI Number for Unknown Individual is 1902896640

Main info

Organization
Inactive
40 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1902896640
Phone
(270) 651-2181
Address
108 BRAVO BLVD
Deactivation Date
20 March 2024

Doctor Profile

Medical School Name
INDIANA UNIVERSITY - SCHOOL OF OPTOMETRY
Secondary Phone
2706512181
Graduation Year
1986 (40 years ago)
PAC ID
3678615150
Group Practice PAC ID
5092784033
Professional Enrollment ID
I20100121000466
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

  • 108, Bravo Boulevard, Glasgow, Barren County, Kentucky, 42141, United States

    GLASGOW, KY 421413478

    Phone: (270) 651-2181

    Fax: (270) 651-2183

    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 14 Open Payments records for all available years, with a total value of $442.

Total Amount is formed as General ($442) + Research ($0) + Ownership ($0) = $442.

Last reported payment date: 2023-11-08 • Largest payer in this snapshot: Ocular Therapeutix, Inc. ($190).

Total Amount

$442

General + Research + Ownership

Payments

14

Total payment records

General Amount

$442

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-11-08

Latest reported date

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99213Established patient office or other outpatient visit, 20-29 minutes395261$0
99214Established patient office or other outpatient visit, 30-39 minutes287163$0
92014Established patient complete exam of visual system150150$0
92134Imaging of retina114110$0
92083Exam of visual field with extended testing8585$0
View full utilization report →

Insurance plans in this area (ZIP 42141)

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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
OPTOMETRYKY92083Measurement of field of vision during daylight conditions146140
OPTOMETRYKY92134Diagnostic imaging of retina5551

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: 5092784033View full group profile
NameSpecialtyState
O P T O M E T R YKY
O P T O M E T R YKY
O P H T H A L M O L O G YKY
O P T O M E T R YKY

Reviews

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Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1902896640.
Should I trust care from Unknown Individual if status is inactive?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
Can you summarize Unknown Individual's specialty in plain language?
Clinically, the directory lists Unknown Individual with Optometrist. Clinical services aligned with this taxonomy classification.
Where does public data place Unknown Individual?
The snapshot lists Glasgow, Kentucky for Unknown Individual; download NPPES for the complete set.
How can I contact Unknown Individual?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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