Provider Demographics
NPI:1750488193
Name:ORDONEZ, XAVIER P (OD)
Entity Type:Individual
Prefix:DR
First Name:XAVIER
Middle Name:P
Last Name:ORDONEZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13124 PHILADELPHIA ST
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-4301
Mailing Address - Country:US
Mailing Address - Phone:562-945-3589
Mailing Address - Fax:562-945-5788
Practice Address - Street 1:13124 PHILADELPHIA ST
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-4301
Practice Address - Country:US
Practice Address - Phone:562-945-3589
Practice Address - Fax:562-945-5788
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11089T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0110890Medicaid
CA1750488193Medicaid
CA1750488193Medicaid
CASD0110890Medicaid