Provider Demographics
NPI:1578617197
Name:REYNOLDS, DONALD P (DO)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:P
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9015 35TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3025
Mailing Address - Country:US
Mailing Address - Phone:425-355-2377
Mailing Address - Fax:
Practice Address - Street 1:620 SE EVERETT MALL WAY
Practice Address - Street 2:#320
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3278
Practice Address - Country:US
Practice Address - Phone:425-355-2377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA815156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician