Individual
MR. KENT DOUGLAS REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2700 14TH AVE SE, ALBANY, OR 97322-6956
(541) 928-1667
(541) 928-1817
Mailing address
2700 14TH AVE SE, ALBANY, OR 97322-6956
(541) 928-1667
(541) 928-1817
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3022ATI
OR
152W00000X
Optometrist
TA1285
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025040
—
OR
05
—
983001400
—
MD
Enumeration date
07/31/2006
Last updated
11/05/2008
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