Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist |
NPI | 1689189656 |
---|---|
Provider Name | Robert Chadd Reynolds |
First Address | Waddell, AZ 85355-9640 |
Second Address | Waddell, AZ 85355-9640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2017 |
Last Update Date | 12/12/2017 |