Provider Demographics
NPI:1568566784
Name:CROSS, JENNIFER JOAN (OD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOAN
Last Name:CROSS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 LAKE ELMO DR STE 1
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-1798
Mailing Address - Country:US
Mailing Address - Phone:406-245-2299
Mailing Address - Fax:406-245-8302
Practice Address - Street 1:1540 LAKE ELMO DR STE 1
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-1798
Practice Address - Country:US
Practice Address - Phone:406-245-2299
Practice Address - Fax:406-245-8302
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT756152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V01293Medicare UPIN