Provider Demographics
NPI:1043326523
Name:XU, XIJING (OD)
Entity Type:Individual
Prefix:
First Name:XIJING
Middle Name:
Last Name:XU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:X
Other - Last Name:XU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2626 WATSON BLVD
Mailing Address - Street 2:EYEGLASS WORLD
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-2950
Mailing Address - Country:US
Mailing Address - Phone:478-273-6858
Mailing Address - Fax:478-542-5304
Practice Address - Street 1:2626 WATSON BLVD
Practice Address - Street 2:EYEGLASS WORLD
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-2950
Practice Address - Country:US
Practice Address - Phone:478-273-6858
Practice Address - Fax:478-542-5304
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001734152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
40377OtherDAVIS VISION
GA000823985BMedicaid
GA1734OtherECPA AND EYE MED
12458OtherSPECTERA
12458OtherSPECTERA
GA1734OtherECPA AND EYE MED
MX0837748OtherDEA
24958OtherAVESIS
88028OtherAVESIS - GA MEDICAID