Kent Douglas Reynolds, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3022ATI Issued in OR

Practice address

2700 14TH Ave SE
Albany, OR 97322-6956

Phone

(541) 928-1667

Fax

(541) 928-1817

NPI assigned

Jul 31, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Southern College of Optometry, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eugene Eye Clinic LLCGroup PAC ID 0244542843, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Eugene Eye Clinic, LLC

  • Ophthalmology Physician
  • Eugene, OR
  • NPI 1952789380
  Medicare reassignment Care Compare group NPD
• Eugene Eye Clinic LLC

  dba Willamette Spectacle Shop

  • Eyewear Supplier
  • Eugene, OR
  • NPI 1912386004
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1225843200000",
    "number": "1043226178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 14TH AVE SE",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973226956",
            "telephone_number": "541-928-1667",
            "fax_number": "541-928-1817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 14TH AVE SE",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973226956",
            "telephone_number": "541-928-1667",
            "fax_number": "541-928-1817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "KENT",
        "middle_name": "DOUGLAS",
        "name_prefix": "Mr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2008-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA1285",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "3022ATI",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025040",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "983001400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heidi Renoud
• Gregory Philip Renyer, DMD
• Katherine Marie Rex
• Nancy Reyes
• Daniel Halsey Reynolds, DMD
• Jenna Riccolo
• Dena Christine Richard
• Katherine Merlyn Richards, CRM
• Andrea Richardson
• Katrin M Ridge, RPH

• Optometrist in Albany, OR
• Providers in Albany, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.