Basic Information
| Provider Information | |||||||||
| NPI: | 1184678575 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REYNOLDS | ||||||||
| FirstName: | MILY | ||||||||
| MiddleName: | WU | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 86-120 FARRINGTON HWY | ||||||||
| Address2: | SUITE C301 | ||||||||
| City: | WAIANAE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967923000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086967021 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 86-120 FARRINGTON HWY | ||||||||
| Address2: | SUITE C301 | ||||||||
| City: | WAIANAE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967923000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086967021 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 07/07/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 499 | HI | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 24999603 | 05 | HI | MEDICAID | 24999602 | 05 | HI | MEDICAID | 24999601 | 05 | HI | MEDICAID |