Unknown Individual – Ophthalmology Physician, NPI 1083673974

Unknown Individual is a healthcare provider. based in Kalamazoo, Michigan. specializing in Ophthalmology Physician. They hold a License No. 4301046147 (MI). The NPI Number for Unknown Individual is 1083673974

Main info

Organization
Inactive
44 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1083673974
Phone
(269) 383-1110
Address
1717 SHAFFER STREET
Deactivation Date
2 November 2022

Doctor Profile

Medical School Name
UNIVERSITY OF MICHIGAN MEDICAL SCHOOL
Secondary Phone
2693831110
Graduation Year
1982 (44 years ago)
PAC ID
7618083064
Professional Enrollment ID
I20110203000627
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

  • 1717, Shaffer Street, Eastwood, Kalamazoo Charter Township, Kalamazoo County, Michigan, 49048, United States

    SUITE 207

    KALAMAZOO, MI 490481625

    Phone: (269) 383-1110

    Fax: (269) 383-1103

    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 49048)

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Provider's Procedures

Unknown Individual performs procedures in Ophthalmology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
OPHTHALMOLOGYMI92012Eye and medical examination for diagnosis and treatment, established patient1414
OPHTHALMOLOGYMI92083Measurement of field of vision during daylight conditions3636

Reviews

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Frequently asked questions

What is Unknown Individual's NPI number?
Unknown Individual's NPI is 1083673974 — the number used across U.S. healthcare to identify this provider.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Ophthalmology Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Kalamazoo?
Unknown Individual currently maps to Kalamazoo, Michigan in this extract.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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