Provider Demographics
NPI:1477881522
Name:CROSS, JARROD (OD)
Entity Type:Individual
Prefix:
First Name:JARROD
Middle Name:
Last Name:CROSS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N MCKEMY AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2654
Mailing Address - Country:US
Mailing Address - Phone:480-961-1865
Mailing Address - Fax:480-961-4605
Practice Address - Street 1:220 N MCKEMY AVE
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2654
Practice Address - Country:US
Practice Address - Phone:480-961-1865
Practice Address - Fax:480-961-4605
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1726152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ162078Medicare PIN
AZZ162075Medicare PIN
AZZ163439Medicare PIN
AZZ163437Medicare PIN
AZZ163441Medicare PIN
AZZ162074Medicare PIN
AZZ162077Medicare PIN
AZZ162079Medicare PIN
AZZ163442Medicare PIN
AZZ162076Medicare PIN
AZZ163440Medicare PIN
AZZ163438Medicare PIN