Active NPI
Mark Paul Reynolds, OD
- Optometrist
- Helena, MT
National Provider Identifier
1326036484
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 425OPT
- Practice address
- 2195 E Custer Ave
Helena, MT 59602-1217 - Phone
- (406) 495-7053
- Fax
- (406) 495-7052
- NPI assigned
- Oct 12, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 425OPT | MT | Primary |
Addresses
Primary practice location
2195 E Custer Ave
Helena, MT 59602-1217
Mailing address
PO Box 1277
East Helena, MT 59635-1277
Phone (406) 495-7052
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 28260 | Other | MT | BCBS |
| 0483912 | Medicaid | MT | |
| 410044874 | Other | MT | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 425OPT | MT | MD | Optometrist |
| 425 | MT | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346198400000",
"number": "1326036484",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1277",
"city": "EAST HELENA",
"state": "MT",
"postal_code": "596351277",
"telephone_number": "406-495-7052",
"fax_number": "406-495-7052"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2195 E CUSTER AVE",
"city": "HELENA",
"state": "MT",
"postal_code": "596021217",
"telephone_number": "406-495-7053",
"fax_number": "406-495-7052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "MARK",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-12",
"last_updated": "2012-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MT",
"license": "425OPT",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "28260",
"state": "MT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0483912",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "410044874",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Helena, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.