Provider Demographics
NPI:1013079474
Name:CROSS, DANNY W (OD)
Entity Type:Individual
Prefix:DR
First Name:DANNY
Middle Name:W
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:PO BOX 4509
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-4509
Mailing Address - Country:US
Mailing Address - Phone:423-569-6822
Mailing Address - Fax:423-569-6823
Practice Address - Street 1:18730 ALBERTA ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-2128
Practice Address - Country:US
Practice Address - Phone:423-569-6822
Practice Address - Fax:423-569-6823
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN717OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
103I416993OtherMEDICARE PTAN
TN3594379Medicaid
TNT61187Medicare UPIN
103I416993OtherMEDICARE PTAN