Provider Demographics
NPI:1891207742
Name:DOUGLAS REYNOLDS, O.D. SANTA ROSA, P.A.
Entity Type:Organization
Organization Name:DOUGLAS REYNOLDS, O.D. SANTA ROSA, P.A.
Other - Org Name:GULF COAST VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-477-1499
Mailing Address - Street 1:460 E NINE MILE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-1441
Mailing Address - Country:US
Mailing Address - Phone:850-477-1499
Mailing Address - Fax:850-479-3359
Practice Address - Street 1:4377 WOODBINE RD
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8792
Practice Address - Country:US
Practice Address - Phone:850-995-4555
Practice Address - Fax:850-995-4556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3828152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty