Unknown Individual – Optometrist, NPI 1073574034

Unknown Individual is a healthcare provider. based in Plymouth, Massachusetts. specializing in Optometrist. They hold a License No. 3288 (MA). The NPI Number for Unknown Individual is 1073574034

Main info

Organization
Inactive
40 Years Of Experience
Name
Unknown Individual
NPI
1073574034
Phone
(508) 888-6393
Address
2277 STATE RD
Deactivation Date
13 December 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1986 (40 years ago)
PAC ID
7012071269
Professional Enrollment ID
I20090209000245
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

  • 2277, State Road, Ellisville, Plymouth, Plymouth County, Massachusetts, 02562, United States

    SUITE F

    PLYMOUTH, MA 023607111

    Phone: (508) 888-6393

    Fax: (508) 833-3551

    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 3 Open Payments records for all available years, with a total value of $230.

Total Amount is formed as General ($230) + Research ($0) + Ownership ($0) = $230.

Last reported payment date: 2023-09-13 • Largest payer in this snapshot: Glaukos Corporation ($113).

Total Amount

$230

General + Research + Ownership

Payments

3

Total payment records

General Amount

$230

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-09-13

Latest reported date

Top Companies

Largest payers in this snapshot

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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
92250Photography of the retina131131$0
92014Established patient complete exam of visual system103103$0
92081Exam of visual field with limited testing7272$0
99214Established patient office or other outpatient visit, 30-39 minutes6868$0
99213Established patient office or other outpatient visit, 20-29 minutes5751$0
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Insurance plans in this area (ZIP 02360)

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Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1073574034 as the unique 10-digit identifier.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Optometrist in the directory — Clinical services aligned with this taxonomy classification.
Where in Massachusetts is Unknown Individual registered?
Use Plymouth, Massachusetts as the headline location for Unknown Individual here.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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