Provider Demographics
NPI:1285639526
Name:REYNOLDS, JAMES D JR (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:REYNOLDS
Suffix:JR
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 1:1680 E BOOKER DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-9405
Mailing Address - Country:US
Mailing Address - Phone:919-938-6101
Mailing Address - Fax:919-938-6103
Practice Address - Street 1:1680 E BOOKER DAIRY RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-9405
Practice Address - Country:US
Practice Address - Phone:919-938-6101
Practice Address - Fax:919-938-6103
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2170152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME410048401OtherRAILROAD MEDICARE
NC2467887246Medicare PIN
ME410048401OtherRAILROAD MEDICARE