Vivid Cranial Prosthetics

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

VIVID CRANIAL PROSTHETICS

Practice address

25615 S Susan LN
Crete, IL 60417-4276

Phone

(312) 273-8826

NPI assigned

Mar 11, 2026

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ava Selmon Green

Title

Owner

Phone

(312) 273-8826

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1773187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773187200000",
    "number": "1043167927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25615 S SUSAN LN",
            "city": "CRETE",
            "state": "IL",
            "postal_code": "604174276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25615 S SUSAN LN",
            "city": "CRETE",
            "state": "IL",
            "postal_code": "604174276",
            "telephone_number": "312-273-8826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIVID CRANIAL PROSTHETICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-03-11",
        "last_updated": "2026-03-11",
        "certification_date": "2026-03-11",
        "status": "A",
        "authorized_official_last_name": "SELMON GREEN",
        "authorized_official_first_name": "AVA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-273-8826"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Douglas Van Til, LCSW
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• Village of Crete
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• Nerissa Vogt, LSW
• Sophilia Walker
• Megan Wall
• Wallace Family Chiropractic, LLC
• Walter Lagestee Incorporated (Walt's Pharmacy #4)

• Durable Medical Equipment & Medical Supplies in Crete, IL
• Providers in Crete, IL by specialty
• Durable Medical Equipment & Medical Supplies in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.