1447242185 NPI number — DR. TONYA MICHELLE REYNOLDSON OD

Table of content: DR. TONYA MICHELLE REYNOLDSON OD (NPI 1447242185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447242185 NPI number — DR. TONYA MICHELLE REYNOLDSON OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYNOLDSON
Provider First Name:
TONYA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REYNOLDSON
Provider Other First Name:
TONYA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1447242185
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/21/2006
NPI Reactivation Date:
04/04/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 HOLLY LN
Provider Second Line Business Mailing Address:
RIVER VALLEY EYE CLINIC P.C
Provider Business Mailing Address City Name:
WAVERLY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37185-0493
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-296-1990
Provider Business Mailing Address Fax Number:
931-296-1899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 HOLLY LN
Provider Second Line Business Practice Location Address:
RIVER VALLEY EYE CLINIC P.C
Provider Business Practice Location Address City Name:
WAVERLY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37185-0493
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-296-1990
Provider Business Practice Location Address Fax Number:
931-296-1899
Provider Enumeration Date:
08/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OD0000002255 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: TN2255 . This is a "EYEMED" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 200721045 . This is a "BOILERMAKERS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4063366 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: TN0255 . This is a "VISION BENEFITS OF AMERIC" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 01038894 . This is a "AMERIGROUP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3719356 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7536377 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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