Organization Active NPI

Crossroads Vision Center, PC

  • Optometrist
  • Oklahoma City, OK
National Provider Identifier
1124380399
Registry record updated Jun 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
923 Issued in OK
Legal business name
CROSSROADS VISION CENTER, PC
Practice address
3200 SW 89TH St
Oklahoma City, OK 73159-7902
Phone
(405) 692-2526
Fax
(405) 692-2187
NPI assigned
Jun 13, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2012

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

Authorized official

Name
Dr. Randel Sterling Hicks, O.D.NPI 1164531109
Title
Owner
Phone
(405) 692-2526

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 923 OK Primary

Addresses

Primary practice location

3200 SW 89TH St
Oklahoma City, OK 73159-7902

Mailing address

3200 SW 89TH St
Oklahoma City, OK 73159-7902
Phone (405) 692-2526

Other identifiers 1

IdentifierTypeStateIssuer
100761420BMedicaidOK

National Provider Directory

National Provider Directory

Locations

3200 SW 89th St
Oklahoma City, OK 73159
Phone (405) 692-2526

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1339545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339545600000",
    "number": "1124380399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 SW 89TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731597902",
            "telephone_number": "405-692-2526",
            "fax_number": "405-692-2187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 SW 89TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731597902",
            "telephone_number": "405-692-2526",
            "fax_number": "405-692-2187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS VISION CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-13",
        "last_updated": "2012-06-13",
        "status": "A",
        "authorized_official_last_name": "HICKS",
        "authorized_official_first_name": "RANDEL",
        "authorized_official_middle_name": "STERLING",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-692-2526",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OK",
            "license": "923",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100761420B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2012; 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.