Unknown Individual – Ophthalmology Physician, NPI 1962405779

Unknown Individual is a healthcare provider. based in Middlesboro, Kentucky. specializing in Ophthalmology Physician. They hold a License No. 30778 (KY). The NPI Number for Unknown Individual is 1962405779

Main info

Organization
Inactive
33 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1962405779
Phone
(606) 248-0932
Address
1502 CUMBERLAND AVE
Deactivation Date
4 January 2023

Doctor Profile

Medical School Name
UNIVERSITY OF KENTUCKY COLLEGE OF MEDICINE
Secondary Phone
6062480932
Graduation Year
1993 (33 years ago)
PAC ID
3476553306
Group Practice PAC ID
9638197262
Professional Enrollment ID
I20100304000360
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

  • Cumberland Avenue, Middlesboro, Middlesborough, Bell County, Kentucky, 40965, United States of America

    MIDDLESBORO, KY 409651223

    Phone: (606) 248-0932

    Fax: (606) 248-1384

    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 40965)

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Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1962405779 when you need to reference Unknown Individual in forms, claims, or directories.
Is Unknown Individual's inactive status permanent?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
What field does Unknown Individual work in?
You can think of Unknown Individual as practicing within Ophthalmology Physician. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Kentucky?
You will see Middlesboro, Kentucky on file for Unknown Individual alongside any extra practice locations.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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