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General NPI Number Information
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NPI Number | 1063532752
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Entity Type | Individual
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Provider Name | RICHARD ERIC REYNOLDS AU.D.
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Gender | Male
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 04/25/2012
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Provider Practice Location Address
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Address Line | 1710 COUNTRY CLUB DR SUITE 102
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City | MANSFIELD
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State | TX
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Zip | 76063-2621
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Country | US
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Telephone | 817-779-6955
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Fax | 817-473-9963
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Provider Business Mailing Address
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Address Line | 400 S HENDERSON ST
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City | FORT WORTH
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State | TX
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Zip | 76104-1017
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Country | US
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Telephone | 817-335-2583
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Fax | 817-335-2597
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 50661
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number |
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License Number State |
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