Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 717OD | TN |
NPI | 1013079474 |
---|---|
Provider Name | Dr. Danny W Cross |
First Address | Oneida, TN 37841-4509 |
Second Address | Oneida, TN 37841-2128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 06/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103I416993 | MEDICARE PTAN (01) | |
3594379 | (05) | TN |
T61187 | (02) | TN |