Unknown Individual – Optometrist, NPI 1477546638

Unknown Individual is a healthcare provider. based in Cookeville, Tennessee. specializing in Optometrist. They hold a License No. OD0000001669 (TN). The NPI Number for Unknown Individual is 1477546638

Main info

Organization
Inactive
31 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1477546638
Phone
(931) 528-1567
Address
768 S WILLOW AVE STE A
Deactivation Date
26 June 2024

Doctor Profile

Medical School Name
SOUTHERN COLLEGE OF OPTOMETRY
Secondary Phone
9315281567
Graduation Year
1995 (31 years ago)
PAC ID
5991812539
Group Practice PAC ID
1355379256
Professional Enrollment ID
I20111209000247
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

Provider Addresses for Unknown Individual

  • 768 S WILLOW AVE STE A

    COOKEVILLE, TN 385013892

    Phone: (931) 528-1567

    Fax: (931) 528-6094

    Type: Location

  • Iris Lane, Lynwood Acres, Crossville, Cumberland County, Tennessee, 38572, United States

    CROSSVILLE, TN 385557528

    Phone: (931) 456-2728

    Fax: (931) 456-5446

    Type: Mailing

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 $25.

Total Amount is formed as General ($25) + Research ($0) + Ownership ($0) = $25.

Last reported payment date: 2023-08-17 • Largest payer in this snapshot: Bausch & Lomb Americas Inc. ($25).

Total Amount

$25

General + Research + Ownership

Payments

1

Total payment records

General Amount

$25

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-08-17

Latest reported date

Top Companies

Largest payers in this snapshot

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.

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 38501)

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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: 1355379256View full group profile
NameSpecialtyState
O P T O M E T R YTN
O P T O M E T R YTN
-TN
O P T O M E T R YTN
O P H T H A L M O L O G YTN
O P T O M E T R YTN
O P T O M E T R YTN
O P T O M E T R YTN
O P H T H A L M O L O G YTN
O P T O M E T R YTN

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1477546638 on file in the registry.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Optometrist. Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on Cookeville, Tennessee.
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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