Provider Demographics
NPI:1215210802
Name:REYNON, JONATHAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:REYNON
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 1:7250 O'KELLY CHAPEL ROAD
Mailing Address - Street 2:STE 200
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519
Mailing Address - Country:US
Mailing Address - Phone:919-883-9987
Mailing Address - Fax:919-887-6381
Practice Address - Street 1:7250 O'KELLY CHAPEL ROAD
Practice Address - Street 2:STE 200
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519
Practice Address - Country:US
Practice Address - Phone:919-883-9987
Practice Address - Fax:919-887-6381
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2301152W00000X, 152WC0802X
PAOEG002561152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12293959OtherCAQH
12293959OtherCAQH