Provider Demographics
NPI:1336393123
Name:REYNOLDS, JENNIFER LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:12711 E 86TH PL N STE 102
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-2663
Mailing Address - Country:US
Mailing Address - Phone:918-376-4100
Mailing Address - Fax:888-299-4619
Practice Address - Street 1:12711 E 86TH PL N STE 102
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-2663
Practice Address - Country:US
Practice Address - Phone:918-376-4100
Practice Address - Fax:888-299-4619
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK2580152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist