Provider Demographics
NPI:1255493946
Name:REYNOLDS, DAVID IAN (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:IAN
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1345 N MONTEBELLO BLVD
Mailing Address - Street 2:INSIDE COSTCO
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-2585
Mailing Address - Country:US
Mailing Address - Phone:323-726-7667
Mailing Address - Fax:323-726-7645
Practice Address - Street 1:1345 N MONTEBELLO BLVD
Practice Address - Street 2:INSIDE COSTCO
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-2585
Practice Address - Country:US
Practice Address - Phone:323-726-7667
Practice Address - Fax:323-726-7645
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA7317T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist