Basic Information
| Provider Information | |||||||||
| NPI: | 1235118761 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REYNOLDS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | OZMENT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 530 CORPORATE CIRCLE | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046370158 | ||||||||
| FaxNumber: | 7046377710 | ||||||||
| Practice Location | |||||||||
| Address1: | 530 CORPORATE CIRCLE | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046370158 | ||||||||
| FaxNumber: | 7046377710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2006 | ||||||||
| LastUpdateDate: | 03/16/2015 | ||||||||
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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 | 174400000X | 17420 | NC | N | Other Service Providers | Specialist | 207W00000X | 17420 | NC | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 1052613 | 01 | SC | WELLCARE OF SC | OTHER | 1440027 | 01 | COVENTRY | OTHER | 71358 | 01 | NC | BCBS | OTHER | P01307753 | 01 | NC | MEDICARE RAILROAD | OTHER | Q17420 | 01 | SC | MEDICAID | OTHER | 30170953 | 01 | SC | SELECT HEALTH | OTHER | 4414449 | 01 | AETNA | OTHER | 8971358 | 05 | NC | MEDICAID |