Provider Demographics
NPI:1861606402
Name:KENDALL, JON H (OD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:H
Last Name:KENDALL
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 1:1125 E 17TH ST
Mailing Address - Street 2:N-455
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2201
Mailing Address - Country:US
Mailing Address - Phone:714-835-0141
Mailing Address - Fax:
Practice Address - Street 1:1125 E 17TH ST
Practice Address - Street 2:N-455
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2201
Practice Address - Country:US
Practice Address - Phone:714-835-0141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6974T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASDOO6974OMedicaid
CAOP6974Medicare ID - Type Unspecified
CASDOO6974OMedicaid
CAOP6974Medicare PIN