Unknown Individual – Ophthalmology Physician, NPI 1053358077

Unknown Individual is a healthcare provider. based in Chehalis, Washington. specializing in Ophthalmology Physician. They hold a License No. MD00031242 (WA). The NPI Number for Unknown Individual is 1053358077

Main info

Organization
Inactive
53 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1053358077
Phone
(360) 242-3008
Address
PO BOX 1506
Deactivation Date
29 January 2026

Doctor Profile

Medical School Name
LOMA LINDA UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
4064542202
Graduation Year
1973 (53 years ago)
PAC ID
3971697343
Group Practice PAC ID
7517864119
Professional Enrollment ID
I20070915000141

Contacts

Secure Messaging
asc.pclichehalis.p1@direct.pcli.nextgenshare.com
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

  • Chehalis Post Office, Northwest Center Street, Chehalis, Lewis County, Washington, United States

    CHEHALIS, WA 985320409

    Phone: (360) 242-3008

    Fax: (360) 807-7687

    Type: Mailing

  • 2517, Northeast Kresky Avenue, Chehalis, Lewis County, Washington, 98532, United States

    CHEHALIS, WA 985322409

    Phone: (360) 748-8632

    Fax: (360) 807-7687

    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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
66821Removal of recurring cataract in lens capsule using a laser707702$0
View full utilization report →

Insurance plans in this area (ZIP 98532)

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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: 7517864119View full group profile
NameSpecialtyState
Certified Registered Nurse Anesthetist (Crna)WA
O P H T H A L M O L O G YWA
O P H T H A L M O L O G YWA
O P T O M E T R YWA
Certified Registered Nurse Anesthetist (Crna)WA
O P T O M E T R YWA
O P T O M E T R YWA
O P T O M E T R YOR
O P H T H A L M O L O G YWA
O P H T H A L M O L O G YWA

Reviews

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Frequently asked questions

Can I use this page to confirm Unknown Individual's NPI?
Yes. Unknown Individual is listed with NPI 1053358077 in the public NPI dataset.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual's specialty?
The listing groups Unknown Individual with Ophthalmology Physician. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Chehalis, Washington in our summary view.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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