Nichole M. Cruz, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2823-035 Issued in WI

Practice address

675 Wolf Rd
Random Lake, WI 53075-1264

Phone

(920) 994-8500

Fax

(920) 994-8550

NPI assigned

Aug 30, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

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

Specialty

Optometry

Education

Southern California College of Optometry, 2000

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Random Lake Medical Center LLC

  • Family Medicine Physician
  • Random Lake, WI
  • NPI 1285854240
  NPD (past)
• Varish Chiropractic Clinics, LLC

  • Chiropractor
  • Howards Grove, WI
  • NPI 1316008055
  NPD (past)

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400457600000",
    "number": "1801906102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 WOLF RD",
            "address_2": "P.O.BOX 2",
            "city": "RANDOM LAKE",
            "state": "WI",
            "postal_code": "530751264",
            "telephone_number": "920-994-8500",
            "fax_number": "920-994-8550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 WOLF RD",
            "city": "RANDOM LAKE",
            "state": "WI",
            "postal_code": "530751264",
            "telephone_number": "920-994-8500",
            "fax_number": "920-994-8550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUZ",
        "first_name": "NICHOLE",
        "middle_name": "M.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2014-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2823-035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38623000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aurora Medical Group, Inc.
• Angela Marie Becker, OTR
• Virginia K Bowen, P.T.
• Angela Cabell, M.S. CCC-SLP
• Jamie L. Carter, OTR
• Michelle L Feierstein, OTR
• Generations Family Dental Care-Random Lake, LLC
• Carolyn Ann Gilley
• Michelle M Grace-Jensen, PT
• Megan C Horn, OTR

• All providers in Random Lake, WI
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.