Unknown Individual – Ophthalmology Physician, NPI 1063402220

Unknown Individual is a healthcare provider. based in Ashland, Oregon. specializing in Ophthalmology Physician. They hold a License No. G58117 (CA). The NPI Number for Unknown Individual is 1063402220

Main info

Organization
Inactive
41 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1063402220
Phone
(541) 488-3192
Address
246 CATALINA DR
Deactivation Date
3 May 2023

Doctor Profile

Medical School Name
VIRGINIA COMMONWEALTH UNIVERSITY, SCHOOL OF MEDICINE
Secondary Phone
5414883192
Graduation Year
1985 (41 years ago)
PAC ID
1153392063
Group Practice PAC ID
5193796191
Professional Enrollment ID
I20120104000353
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

  • 246, Catalina Drive, Ashland, Jackson County, Oregon, 97520, United States

    SUITE 1

    ASHLAND, OR 975201624

    Phone: (541) 488-3192

    Fax: (541) 488-0646

    Type: Mailing

  • 246, Catalina Drive, Billings Ranch, Ashland, Jackson County, Oregon, 97520, United States

    SUITE 1

    ASHLAND, OR 975201624

    Phone: (541) 488-3192

    Fax: (541) 488-0646

    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 97520)

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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
OPHTHALMOLOGYOR92134Diagnostic imaging of retina1933484

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: 5193796191View full group profile
NameSpecialtyState
DR. JOHN DAVID HYATT (M.D.)
O P H T H A L M O L O G YOR
ZAFAR SINGH GILL (MD)
O P H T H A L M O L O G YCO
DR. CHRISTINE READ GONZALES (M.D.)
O P H T H A L M O L O G YOR

Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1063402220 for Unknown Individual, then check state licensing separately.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What is Unknown Individual's primary classification?
Ophthalmology Physician is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
Where should I expect Unknown Individual on a map?
Expect Ashland, Oregon as a primary anchor for Unknown Individual unless the record lists multiple sites.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.