Unknown Individual – Optometrist, NPI 1336217520

Unknown Individual is a healthcare provider. based in Fort gordon, Georgia. specializing in Optometrist. They hold a License No. OP 455 (DC). The NPI Number for Unknown Individual is 1336217520

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1336217520
Phone
(706) 787-2720
Address
300 W HOSPITAL ROAD, EISENHOWER ARMY MEDICAL CENTER
Deactivation Date
26 June 2024
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

  • 300 W HOSPITAL ROAD, EISENHOWER ARMY MEDICAL CENTER

    ATTN CREDENTIALS

    FORT GORDON, GA 309055650

    Phone: (706) 787-2720

    Fax: (706) 787-8176

    Type: Mailing

  • Eisenhower Army Medical Center, 300, East Hospital Road, Augusta, Richmond County, Georgia, 30905, United States

    ATTN CREDENTIALS

    FORT GORDON, GA 309055650

    Phone: (706) 787-2720

    Fax: (706) 787-8176

    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 30905)

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Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1336217520 as the unique 10-digit identifier.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
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.
Where in Georgia is Unknown Individual registered?
Use Fort Gordon, Georgia as the headline location for Unknown Individual here.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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