MEDICARE: NATIONWIDE OPTOMETRY P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1972676997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONWIDE OPTOMETRY P.C.

Provider Business Mailing Address
First Line	:	955 W SOUTHERN AVE STE 101
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85210-4903
Country	:	US
Telephone Number	:	480-961-1865
Fax Number	:	480-893-8172

Provider Business Practice Location Address
First Line	:	2840 HIGHWAY 95 STE 416-418
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-7792
Country	:	US
Telephone Number	:	928-704-1808
Fax Number	:	928-704-1814

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JARROD CROSS
Credential	:	OD
Telephone Number	:	509-201-0051

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	11/14/2024

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