Individual provider Active NPI

Nicole Suzanne Crossland

  • Optometrist
  • Springfield, OR
National Provider Identifier
1295933018
Registry record updated Apr 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3222ATI Issued in OR
Practice address
840 A St
Springfield, OR 97477-4710
Phone
(541) 747-0616
Fax
(541) 747-0617
NPI assigned
Jul 3, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3222ATI OR Primary

Addresses

Primary practice location

840 A St
Springfield, OR 97477-4710

Mailing address

840 A St
Springfield, OR 97477-4710
Phone (541) 726-5055

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070828001068 OR Practitioner - Optometry 7113019670 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Complete Vision Center PCGroup PAC ID 9234181843, 3 clinicians

Practice addresses (Care Compare)

840 A St
Springfield, OR 97477-4710
Phone (541) 747-0616

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery16

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3222ATIORMDOptometrist

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1183420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745280000000",
    "number": "1295933018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 A ST",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974774710",
            "telephone_number": "541-726-5055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 A ST",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974774710",
            "telephone_number": "541-747-0616",
            "fax_number": "541-747-0617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROSSLAND",
        "first_name": "NICOLE",
        "middle_name": "SUZANNE",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-03",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "3222ATI",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, OR

Sources for this page

Verify at the official NPI Registry.