Provider Demographics
NPI:1932194891
Name:REYNOLDS-TEMPLE, CYNTHIA (OD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:
Last Name:REYNOLDS-TEMPLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:866-795-4020
Practice Address - Street 1:5331 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20781-1926
Practice Address - Country:US
Practice Address - Phone:240-391-8989
Practice Address - Fax:240-391-8940
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-008464152W00000X
VA0618002370152W00000X
IL346002140152W00000X
DCOP1000310152W00000X
MDTA2447152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633373OtherBLUE CROSS BLUE SHIELD
ILL95270/357801Medicare ID - Type Unspecified
ILU48498Medicare UPIN