Provider Demographics
NPI:1275746356
Name:CHRISTOPHER J. ORENIC OD INC
Entity Type:Organization
Organization Name:CHRISTOPHER J. ORENIC OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:ORENIC
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:310-321-6990
Mailing Address - Street 1:2101 ROSECRANS AVE
Mailing Address - Street 2:SUITE 1215
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245
Mailing Address - Country:US
Mailing Address - Phone:310-321-6990
Mailing Address - Fax:310-321-6170
Practice Address - Street 1:2101 ROSECRANS AVE
Practice Address - Street 2:SUITE 1215
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245
Practice Address - Country:US
Practice Address - Phone:310-321-6990
Practice Address - Fax:310-321-6170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10056T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU61098Medicare UPIN
CAW20330Medicare ID - Type UnspecifiedGROUP MEDICARE ID NUMBER