Healthcare Provider Details

I. General information

NPI: 1891752259
Provider Name (Legal Business Name): JEFFREY L REYNOLDS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 CHAMPION DR STE 100
HAGERSTOWN MD
21740-6665
US

IV. Provider business mailing address

2661 RIVA RD STE 1030
ANNAPOLIS MD
21401-7131
US

V. Phone/Fax

Practice location:
  • Phone: 301-791-0888
  • Fax: 301-791-3611
Mailing address:
  • Phone: 410-571-8733
  • Fax: 410-571-6309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA1354
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618001208
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: