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General NPI Number Information
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NPI Number | 1346717113
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Entity Type | Organization
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Legal Business Name | JOE A. REYNOLDS, OD, INC.
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Dates
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Enumeration Date | 10/30/2018
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Last Update Date | 12/04/2020
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Provider Practice Location Address
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Address Line | 1212 GRAND AVE STE 14
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City | BILLINGS
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State | MT
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Zip | 59102-4259
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Country | US
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Telephone | 406-259-6786
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Fax |
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Provider Business Mailing Address
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Address Line | 627 MEADOWCREST DR
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City | MT WASHINGTON
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State | KY
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Zip | 40047-6486
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Country | US
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Telephone | 812-272-6319
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH ALVIN REYNOLDS
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Credential | OD
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Telephone | 812-272-6319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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