Basic Information
| Provider Information | |||||||||
| NPI: | 1063532752 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REYNOLDS | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | ERIC | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 S HENDERSON ST | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761041017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173352583 | ||||||||
| FaxNumber: | 8173352597 | ||||||||
| Practice Location | |||||||||
| Address1: | 1710 COUNTRY CLUB DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | MANSFIELD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760632621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177796955 | ||||||||
| FaxNumber: | 8174739963 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 04/25/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 50661 | TX | Y | Speech, Language and Hearing Service Providers | Audiologist | 237600000X | N | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |
No ID Information.