Unknown Individual – Optometrist, NPI 1023005386

Unknown Individual is a healthcare provider. based in Saint cloud, Minnesota. specializing in Optometrist. They hold a License No. 2909 (MN). The NPI Number for Unknown Individual is 1023005386

Main info

Organization
Inactive
23 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1023005386
Phone
(320) 253-2441
Address
1545 NORTHWAY DR
Deactivation Date
22 October 2021

Doctor Profile

Medical School Name
SOUTHERN COLLEGE OF OPTOMETRY
Secondary Phone
3202532441
Graduation Year
2003 (23 years ago)
PAC ID
0941231617
Group Practice PAC ID
0345271011
Professional Enrollment ID
I20050823000770
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

  • Northway Drive, Saint Cloud, Stearns County, Minnesota, 56303, United States

    STE 120

    SAINT CLOUD, MN 563031940

    Phone: (320) 253-2441

    Fax: (320) 253-2446

    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 56303)

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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
OPTOMETRYMN92083Measurement of field of vision during daylight conditions1616

Reviews

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Frequently asked questions

Is there an official ID for Unknown Individual in U.S. healthcare records?
The official identifier for Unknown Individual is NPI 1023005386.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What clinical focus is listed for Unknown Individual?
At a glance, Unknown Individual is tied to Optometrist. Clinical services aligned with this taxonomy classification.
Where in Minnesota is Unknown Individual registered?
Use Saint Cloud, Minnesota as the headline location for Unknown Individual here.
Does Unknown Individual accept insurance?
Insurance participation is not part of the core NPI extract — call the plan or office to confirm.

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