Provider Demographics
NPI:1144435207
Name:REYNOLDS & ANLIKER EYE PHYSICIANS & SURGEONS, PA
Entity type:Organization
Organization Name:REYNOLDS & ANLIKER EYE PHYSICIANS & SURGEONS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPHTHALMOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-342-6989
Mailing Address - Street 1:1602 W 15TH AVE
Mailing Address - Street 2:STE B
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-5672
Mailing Address - Country:US
Mailing Address - Phone:620-342-6989
Mailing Address - Fax:620-342-2262
Practice Address - Street 1:1602 W 15TH AVE
Practice Address - Street 2:STE B
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-5672
Practice Address - Country:US
Practice Address - Phone:620-342-6989
Practice Address - Fax:620-342-2262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS016873Medicare ID - Type UnspecifiedGROUP MEDICARE AND BCBS #