Provider Demographics
NPI:1316905722
Name:REYNOLDS, DAVID MORGAN (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MORGAN
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1027 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-8186
Practice Address - Country:US
Practice Address - Phone:336-996-2020
Practice Address - Fax:336-996-8860
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1554152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
44039OtherDAVIS
118179OtherEYEMED
26522OtherSPECTERA
NC093G3OtherBCBS NC
NC89093G3Medicaid
2471480Medicare ID - Type Unspecified