MEDICARE: KATHRYN ORDONEZ OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	34167	CA

General Provider Information

NPI Number	:	1821560418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN ORDONEZ OD

Provider Business Mailing Address
First Line	:	419 SMOKY CIR
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-7446
Country	:	US
Telephone Number	:	619-592-5805
Fax Number	:

Provider Business Practice Location Address
First Line	:	3434 4TH AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-4911
Country	:	US
Telephone Number	:	619-222-2020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2018
Last Update Date	:	12/20/2018

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Directions to “ KATHRYN ORDONEZ OD” Practice Location

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