Provider Demographics
NPI:1881035087
Name:REYNOLDS, BROOKE LAUREN (OD)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:LAUREN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4305 BUTLER HILL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3718
Mailing Address - Country:US
Mailing Address - Phone:314-487-4744
Mailing Address - Fax:
Practice Address - Street 1:1259 MAIN ST
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052-3852
Practice Address - Country:US
Practice Address - Phone:636-461-0470
Practice Address - Fax:314-845-5956
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013021232152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist