Active NPI
Jordan Green, OD
- Optometrist
- Costa Mesa, CA
National Provider Identifier
1568359529
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 36035
- Practice address
- 1545 Adams Ave Ste 100
Costa Mesa, CA 92626-3875 - Phone
- (714) 545-9162
- Fax
- (714) 241-1345
- NPI assigned
- Jun 23, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 36035 | CA | Primary |
Addresses
Primary practice location
1545 Adams Ave Ste 100
Costa Mesa, CA 92626-3875
Mailing address
34 Lyon RDG
Aliso Viejo, CA 92656-5279
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1545 Adams Ave
Suite 100
Costa Mesa, CA 92626-3875
Phone (714) 545-9162
4505 Barranca Pkwy
Suite C
Irvine, CA 92604-4797
Phone (949) 857-0676
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36035 | CA | MD | General Practice Dentistry |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Optometrist
- Costa Mesa, CA
- NPI 1851574958
-
- Optometrist
- Irvine, CA
- NPI 1891232096
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1750636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1764806400000",
"number": "1568359529",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34 LYON RDG",
"city": "ALISO VIEJO",
"state": "CA",
"postal_code": "926565279",
"fax_number": "714-241-1345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1545 ADAMS AVE STE 100",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926263875",
"telephone_number": "714-545-9162",
"fax_number": "714-241-1345"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "JORDAN",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-06-23",
"last_updated": "2025-12-04",
"certification_date": "2025-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "36035",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Costa Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.