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 1:955 W SOUTHERN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-4903
Mailing Address - Country:US
Mailing Address - Phone:480-961-1865
Mailing Address - Fax:480-893-8172
Practice Address - Street 1:4386 N ORACLE RD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-1765
Practice Address - Country:US
Practice Address - Phone:520-887-4435
Practice Address - Fax:520-887-2315
Is Sole Proprietor?:No
Enumeration Date:2009-12-01
Last Update Date:2024-08-06
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
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AZZ162074Medicare PIN
AZZ162077Medicare PIN
AZZ162079Medicare PIN
AZZ163442Medicare PIN
AZZ162076Medicare PIN
AZZ163440Medicare PIN
AZZ163438Medicare PIN