Provider Demographics
NPI:1669432332
Name:REYNOLDS, CHRISTOPHER JOHN (OD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JOHN
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 1:8334 PINEVILLE MATTHEWS RD
Mailing Address - Street 2:SUITE 103-186
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3774
Mailing Address - Country:US
Mailing Address - Phone:888-628-1902
Mailing Address - Fax:888-628-1902
Practice Address - Street 1:10615 WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-9006
Practice Address - Country:US
Practice Address - Phone:888-628-1902
Practice Address - Fax:888-628-1902
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1289152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7909777Medicaid
NC2468859Medicare PIN
NC7909777Medicaid