Provider Demographics
NPI:1164560769
Name:REYNOLDS, GEOFFREY ERIC (OD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:ERIC
Last Name:REYNOLDS
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 1:95-390 KUAHELANI AVE
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1192
Mailing Address - Country:US
Mailing Address - Phone:808-623-2866
Mailing Address - Fax:808-623-7255
Practice Address - Street 1:95-390 KUAHELANI AVE
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-1192
Practice Address - Country:US
Practice Address - Phone:808-623-2866
Practice Address - Fax:808-623-7255
Is Sole Proprietor?:No
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI0491152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI223990OtherHMSA
HI223990OtherHMSA