Provider Demographics
NPI:1235242678
Name:SMITH, DARREN SCOTT (OD)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:SCOTT
Last Name:SMITH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 168
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-0168
Mailing Address - Country:US
Mailing Address - Phone:502-839-5113
Mailing Address - Fax:502-839-9831
Practice Address - Street 1:500 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-1306
Practice Address - Country:US
Practice Address - Phone:502-839-5113
Practice Address - Fax:502-839-9831
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1390DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1169150OtherCHA
KY77013902Medicaid
KYP00204906OtherRAILROAD MEDICARE
KY9038878OtherCIGNA
KY000000217614OtherANTHEM BC/BS
KY5089659OtherAETNA
KY000000217614OtherANTHEM BC/BS
KYP00204906OtherRAILROAD MEDICARE
KY9038878OtherCIGNA