Healthcare Provider Details

I. General information

NPI: 1447770490
Provider Name (Legal Business Name): NATIONWIDE OPTOMETRY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 S IDAHO RD STE 170
APACHE JUNCTION AZ
85119-0007
US

IV. Provider business mailing address

955 W SOUTHERN AVE STE 101
MESA AZ
85210-4903
US

V. Phone/Fax

Practice location:
  • Phone: 480-983-3438
  • Fax: 480-288-4592
Mailing address:
  • Phone: 480-961-1865
  • Fax: 480-893-8172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: JARROD CROSS
Title or Position: PRESIDENT
Credential: OD
Phone: 509-201-0051