Provider Demographics
NPI:1821187063
Name:REYNOLDS, WILLIAM ROY (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROY
Last Name:REYNOLDS
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 1:5166 SUNSET BLVD
Mailing Address - Street 2:SUITE J
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9258
Mailing Address - Country:US
Mailing Address - Phone:803-996-2020
Mailing Address - Fax:803-808-2917
Practice Address - Street 1:5166 SUNSET BLVD
Practice Address - Street 2:SUITE J
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9258
Practice Address - Country:US
Practice Address - Phone:803-996-2020
Practice Address - Fax:803-808-2917
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1291152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD12918Medicaid
SCAA0710Medicare PIN
SCV03246Medicare UPIN