Unknown Individual – Optometrist, NPI 1235214628

Unknown Individual is a healthcare provider. based in Sparks, Nevada. specializing in Optometrist. They hold a License No. NV169 (NV). The NPI Number for Unknown Individual is 1235214628

Main info

Organization
Inactive
48 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1235214628
Phone
(775) 353-5665
Address
1261 BARING BLVD
Deactivation Date
19 March 2026

Doctor Profile

Medical School Name
OHIO STATE UNIVERSITY - COLLEGE OF OPTOMETRY
Secondary Phone
7753592020
Graduation Year
1978 (48 years ago)
PAC ID
7618010729
Group Practice PAC ID
1052390655
Professional Enrollment ID
I20100211000119
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 1261, Baring Boulevard, Sparks, Washoe County, Nevada, 89434, United States

    SPARKS, NV 894348673

    Phone: (775) 353-5665

    Fax: (775) 353-5660

    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 1 Open Payments records for all available years, with a total value of $22.

Total Amount is formed as General ($22) + Research ($0) + Ownership ($0) = $22.

Last reported payment date: 2023-09-06 • Largest payer in this snapshot: Alcon Vision LLC ($22).

Total Amount

$22

General + Research + Ownership

Payments

1

Total payment records

General Amount

$22

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-09-06

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
Alcon Vision LLC$22
View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20100211000119IOptometryNVTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

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
92014Established patient complete exam of visual system4545$0
99213Established patient office or other outpatient visit, 20-29 minutes1312$0
92250Photography of the retina1212$0
View full utilization report →

Insurance plans in this area (ZIP 89434)

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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: 1052390655View full group profile
NameSpecialtyState
O P T O M E T R YNV
O P T O M E T R YOR
-NV
O P T O M E T R YNV
O P T O M E T R YNV
-NV
O P T O M E T R YNV
O P T O M E T R YNV
O P T O M E T R YNV
O P T O M E T R YIL

Reviews

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Frequently asked questions

What number should I use to identify Unknown Individual for billing?
Administrative and clinical systems typically use NPI 1235214628 for Unknown Individual.
Should I call the clinic if Unknown Individual is inactive here?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
Which specialty label fits Unknown Individual?
NPPES ties Unknown Individual to Optometrist in the taxonomy section. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to Sparks, Nevada in registry-derived data.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.