Unknown Individual – Ophthalmology Physician, NPI 1124230685

Unknown Individual is a healthcare provider. based in Portland, Oregon. specializing in Ophthalmology Physician. They hold a License No. MD00048337 (WA). The NPI Number for Unknown Individual is 1124230685

Main info

Organization
Inactive
25 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1124230685
Phone
(206) 858-7000
Address
PO BOX 6989
Deactivation Date
28 January 2022

Doctor Profile

Medical School Name
LOMA LINDA UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
2065286000
Graduation Year
2001 (25 years ago)
PAC ID
9436240108
Group Practice PAC ID
6002728532
Professional Enrollment ID
I20070809000466
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

  • Portland Post Office, 320, Main Street, Gildersleeve, Portland, Lower Connecticut River Valley Planning Region, Connecticut, 06480, United States

    MAIL STOP 18913

    PORTLAND, OR 972286989

    Phone: (206) 858-7000

    Fax: (206) 858-7050

    Type: Mailing

  • Northwest Outpatient Medical Center, 10330, Meridian Avenue North, Northgate, Seattle, King County, Washington, 98133, United States

    SUITE 370

    SEATTLE, WA 981339451

    Phone: (206) 528-6000

    Fax: (206) 528-0014

    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 97228)

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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
OPHTHALMOLOGYWA92083Measurement of field of vision during daylight conditions2424
OPHTHALMOLOGYWA92134Diagnostic imaging of retina6866

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: 6002728532View full group profile
NameSpecialtyState
ALI MAINAYAR
O P T O M E T R YWA
MRS. JESSICA N COUCH
O P T O M E T R YWA
DR. KIRK THOMPSON (OD)
-WA
ROBERT NICHOLAS VELAZQUEZ (CRNA)
-OR
DR. LAURA SPENCE KEARSLEY (M.D.)
O P H T H A L M O L O G YCA
DR. MARK A KONTOS (MD)
O P H T H A L M O L O G YFL
EMILY ROSE FREEMAN (OD, MS)
O P T O M E T R YWA
DR. LEIGH GONGAWARE (OD)
O P T O M E T R YWA
KRISTI L BAILEY (MD)
O P H T H A L M O L O G YOR
MS. KATHRYN D. LANG (CRNA)
Certified Registered Nurse Anesthetist (Crna)TX

Reviews

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Frequently asked questions

What is the standard ID for Unknown Individual in the U.S.?
In the U.S., Unknown Individual is identified by NPI 1124230685.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What does the directory say Unknown Individual does?
Insurance directories may phrase it differently, but here Unknown Individual maps to Ophthalmology Physician. Clinical services aligned with this taxonomy classification.
Can patients visit Unknown Individual in Portland, Oregon?
For routing, start with Portland, Oregon for Unknown Individual, then verify phone and hours locally.
Why is information missing for Unknown Individual?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.