Healthcare Provider Details

I. General information

NPI: 1447242185
Provider Name (Legal Business Name): TONYA MICHELLE REYNOLDSON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TONYA REYNOLDSON O.D.

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date: 03/21/2006
Reactivation Date: 04/04/2006

III. Provider practice location address

215 HOLLY LN RIVER VALLEY EYE CLINIC P.C
WAVERLY TN
37185-0493
US

IV. Provider business mailing address

215 HOLLY LN RIVER VALLEY EYE CLINIC P.C
WAVERLY TN
37185-0493
US

V. Phone/Fax

Practice location:
  • Phone: 931-296-1990
  • Fax: 931-296-1899
Mailing address:
  • Phone: 931-296-1990
  • Fax: 931-296-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD0000002255
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: