Unknown Individual – Ophthalmology Physician, NPI 1811982820

Ophthalmology Physician

Unknown Individual is a healthcare provider. based in Fraser, Michigan. specializing in Ophthalmology Physician. They hold a License No. 4301026409 (MI). The NPI Number for Unknown Individual is 1811982820

Main info

Organization

Inactive

62 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1811982820

Phone

(586) 296-7250

Address

PO BOX 26010

Deactivation Date

26 June 2024

Doctor Profile

Medical School Name

WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE

Secondary Phone

5862967250

Graduation Year

1964 (62 years ago)

PAC ID

6103807664

Group Practice PAC ID

1254611809

Professional Enrollment ID

I20070403000271

Contacts

Secure Messaging

nczajkowski@frasereye.direct.eyemdemr.com

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness85

Years active:0State licenses:1Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

PO BOX 26010
FRASER, MI 480266010
Phone: (586) 296-7250
Fax: (586) 296-0276
Type: Mailing
Fraser Eye, 33080, Utica Road, Fraser, Macomb County, Michigan, 48026, United States
FRASER, MI 480262038
Phone: (586) 296-7250
Fax: (586) 296-0276
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 48026)

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Provider's Procedures

Unknown Individual performs procedures in Ophthalmology Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
OPHTHALMOLOGY	MI	92012	Eye and medical examination for diagnosis and treatment, established patient	117	110
OPHTHALMOLOGY	MI	92134	Diagnostic imaging of retina	231	225

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: 1254611809View full group profile

Name	Specialty	State
KRISTI LEIGH MICHELS (MD)	O P H T H A L M O L O G Y	MI
Unknown Individual	-	MI
DR. RACHEL ANNE DANDAR (MD)	O P H T H A L M O L O G Y	MI
KATE MARIE VANDERHOOF (OD)	O P T O M E T R Y	MI
RYAN M JABER (M.D.)	O P H T H A L M O L O G Y	OH
ROMAN IGOREVICH KRIVOCHENITSER (M.D.)	O P H T H A L M O L O G Y	MI
YI LING DAI (MD)	O P H T H A L M O L O G Y	MI
DAVID LUIGI MANZO (M.D.)	O P H T H A L M O L O G Y	MI
DR. MAHDI BASHA (D.O.)	O P H T H A L M O L O G Y	MI
DR. JOSEPH TAN (M.D.)	O P H T H A L M O L O G Y	PA