Unknown Individual – Ophthalmology Physician, NPI 1114916178

Unknown Individual is a healthcare provider. based in Salt lake city, Utah. specializing in Ophthalmology Physician. They hold a License No. 5430716-1204 (UT). The NPI Number for Unknown Individual is 1114916178

Main info

Organization
Inactive
44 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1114916178
Phone
(801) 213-3900
Address
PO BOX 413075
Deactivation Date
5 June 2025

Doctor Profile

Medical School Name
OKLAHOMA STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE
Secondary Phone
8015818915
Graduation Year
1982 (44 years ago)
PAC ID
3274626734
Group Practice PAC ID
0941525273
Professional Enrollment ID
I20070829000891

Contacts

Secure Messaging
jbeson123772@direct.med.utah.edu
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

  • PO BOX 413075

    SALT LAKE CITY, UT 841413075

    Phone: (801) 213-3900

    Type: Mailing

  • Mario Capecchi Drive, Salt Lake City, Salt Lake County, Utah, 84412, United States

    SALT LAKE CITY, UT 841320005

    Phone: (801) 581-2352

    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 84141)

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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: 0941525273View full group profile
NameSpecialtyState
-UT
-UT
Emergency MedicineCO
-UT
A N E S T H E S I O L O G YUT
Physician AssistantUT
-IL
Plastic And Reconstructive SurgeryOH
Physician AssistantCA
A N E S T H E S I O L O G YUT

Reviews

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Frequently asked questions

What is the registry number for Unknown Individual?
The registry entry for Unknown Individual shows NPI 1114916178.
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.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to Salt Lake City, Utah in registry-derived data.
What is the difference between NPI and a medical license?
An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.

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