Individual
JENNIFER REYNOLDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1501 STATE ST, NEW ALBANY, IN 47150-4911
(812) 945-1162
Mailing address
1501 STATE ST, NEW ALBANY, IN 47150-4911
(812) 945-1162
(812) 945-5592
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1670DT
KY
152W00000X
Optometrist
Primary
18003416A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000510856
ANTHEM BCBS
KY
05
—
200868720
—
IN
05
—
7100002840
—
KY
01
—
P00766631
RR MEDICARE
IN
Enumeration date
10/25/2006
Last updated
06/14/2022
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