Unknown Individual – Optometrist, NPI 1083663629

Unknown Individual is a healthcare provider. based in Nanticoke, Pennsylvania. specializing in Optometrist. They hold a License No. OEG000802 (PA). The NPI Number for Unknown Individual is 1083663629

Main info

Organization
Inactive
43 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1083663629
Phone
(570) 735-6000
Address
245 S PROSPECT STREET
Deactivation Date
22 September 2022

Doctor Profile

Medical School Name
PENNSYLVANIA COLLEGE OF OPTOMETRY
Secondary Phone
-
Graduation Year
1983 (43 years ago)
PAC ID
2264590207
Professional Enrollment ID
I20081021000360
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

  • 245, South Prospect Street, Nanticoke, Luzerne County, Pennsylvania, 18634, United States

    NANTICOKE, PA 18634

    Phone: (570) 735-6000

    Fax: (570) 735-5300

    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.

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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 18634)

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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
OPTOMETRYPA92083Measurement of field of vision during daylight conditions1916
OPTOMETRYPA92134Diagnostic imaging of retina6865

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1083663629 as the unique 10-digit identifier.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What clinical focus is listed for Unknown Individual?
At a glance, Unknown Individual is tied to Optometrist. Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Nanticoke?
Unknown Individual currently maps to Nanticoke, Pennsylvania in this extract.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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