Provider Demographics
NPI:1184678575
Name:REYNOLDS, MILY WU (OD)
Entity Type:Individual
Prefix:DR
First Name:MILY
Middle Name:WU
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86-120 FARRINGTON HWY
Mailing Address - Street 2:SUITE C301
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-3000
Mailing Address - Country:US
Mailing Address - Phone:808-696-7021
Mailing Address - Fax:
Practice Address - Street 1:86-120 FARRINGTON HWY
Practice Address - Street 2:SUITE C301
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-3000
Practice Address - Country:US
Practice Address - Phone:808-696-7021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI499152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI24999603Medicaid
HI24999602Medicaid
HI24999601Medicaid
HIU73911Medicare UPIN
HI24999602Medicaid
HI24999601Medicaid