Provider Demographics
NPI:1417164534
Name:REYNOLDSON & REYNOLDSON CHRTD
Entity Type:Organization
Organization Name:REYNOLDSON & REYNOLDSON CHRTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:M
Authorized Official - Last Name:REYNOLDSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-238-1104
Mailing Address - Street 1:1208 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-2061
Mailing Address - Country:US
Mailing Address - Phone:785-238-1104
Mailing Address - Fax:785-238-2325
Practice Address - Street 1:1208 W 8TH ST
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-2061
Practice Address - Country:US
Practice Address - Phone:785-238-1104
Practice Address - Fax:785-238-2325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1107-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS650865OtherBS SOLO
KS650542OtherBS GROUP
KS650865OtherBS SOLO
KS650542Medicare PIN
KS650542OtherBS GROUP