Provider Demographics
NPI:1790876654
Name:SMART, DANNY RUSSELL JR (OD)
Entity type:Individual
Prefix:DR
First Name:DANNY
Middle Name:RUSSELL
Last Name:SMART
Suffix:JR
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 BRULE ST BLDG 871
Mailing Address - Street 2:
Mailing Address - City:FORT KNOX
Mailing Address - State:KY
Mailing Address - Zip Code:40121-6100
Mailing Address - Country:US
Mailing Address - Phone:502-626-9844
Mailing Address - Fax:502-624-0482
Practice Address - Street 1:200 BRULE ST BLDG 871
Practice Address - Street 2:
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121-6100
Practice Address - Country:US
Practice Address - Phone:502-626-9844
Practice Address - Fax:502-624-0482
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4492152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP0011634OtherRAILROAD MEDICARE
OHP0011634OtherRAILROAD MEDICARE
OHSM0864102Medicare PIN