Unknown Individual – Optometrist, NPI 1053484170

Unknown Individual is a healthcare provider. based in Snohomish, Washington. specializing in Optometrist. They hold a License No. 3566-TX (WA). The NPI Number for Unknown Individual is 1053484170

Main info

Organization
Inactive
26 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1053484170
Phone
(360) 568-1551
Address
629 AVENUE D
Deactivation Date
12 April 2022

Doctor Profile

Medical School Name
NEW ENGLAND COLLEGE OF OPTOMETRY
Secondary Phone
-
Graduation Year
2000 (26 years ago)
PAC ID
6709965783
Professional Enrollment ID
I20080501000389
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience18
Completeness75
Years active:0State licenses:2Digital endpointsOther names

Loading map...

Provider Addresses for Unknown Individual

  • 629, Avenue D, North Snohomish, Snohomish, Snohomish County, Washington, 98290, United States

    SUITE 2

    SNOHOMISH, WA 98290

    Phone: (360) 568-1551

    Fax: (360) 568-9487

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

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 98290)

Loading plans...

Reviews

All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.

No reviews yet. Be the first to share your experience — your opinion helps families compare providers.

Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1053484170 when you need to reference Unknown Individual in forms, claims, or directories.
What is the next step if Unknown Individual is inactive?
Treat inactive as a signal to verify Unknown Individual through official channels.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Optometrist for Unknown Individual. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Washington?
You will see Snohomish, Washington on file for Unknown Individual alongside any extra practice locations.
What if Snohomish, Washington seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.