Provider Demographics
NPI:1447242185
Name:REYNOLDSON, TONYA MICHELLE (OD)
Entity Type:Individual
Prefix:DR
First Name:TONYA
Middle Name:MICHELLE
Last Name:REYNOLDSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:TONYA
Other - Middle Name:
Other - Last Name:REYNOLDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:215 HOLLY LN
Mailing Address - Street 2:RIVER VALLEY EYE CLINIC P.C
Mailing Address - City:WAVERLY
Mailing Address - State:TN
Mailing Address - Zip Code:37185-0493
Mailing Address - Country:US
Mailing Address - Phone:931-296-1990
Mailing Address - Fax:931-296-1899
Practice Address - Street 1:215 HOLLY LN
Practice Address - Street 2:RIVER VALLEY EYE CLINIC P.C
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-0493
Practice Address - Country:US
Practice Address - Phone:931-296-1990
Practice Address - Fax:931-296-1899
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2020-08-27
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
TNOD0000002255152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN2255OtherEYEMED
TN200721045OtherBOILERMAKERS
TN4063366OtherBLUE CROSS BLUE SHIELD
TNTN0255OtherVISION BENEFITS OF AMERIC
TN01038894OtherAMERIGROUP
TN3719356Medicaid
TN7536377OtherAETNA
TNTN0255OtherVISION BENEFITS OF AMERIC
TN5012530001Medicare NSC
TN3719356Medicare PIN