Provider Demographics
NPI:1174585970
Name:REYNOLDS, LINDA SUSAN (OD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:SUSAN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 NORVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-3714
Mailing Address - Country:US
Mailing Address - Phone:843-532-4247
Mailing Address - Fax:844-394-2068
Practice Address - Street 1:7400 RIVERS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4644
Practice Address - Country:US
Practice Address - Phone:843-824-2424
Practice Address - Fax:843-572-0395
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1229152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC50961OtherDAVIS VISION
SC24123OtherSPECTERA
SCD12298Medicaid
SCHU1732118OtherHIGHMARK BC/BS
SCHU1732118OtherHIGHMARK BC/BS