Provider Demographics
NPI:1881785723
Name:WAYNESVILLE FAMILY VISION
Entity type:Organization
Organization Name:WAYNESVILLE FAMILY VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:SMART
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:513-897-2211
Mailing Address - Street 1:PO BOX 1169
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45068-1169
Mailing Address - Country:US
Mailing Address - Phone:513-897-2211
Mailing Address - Fax:513-897-2213
Practice Address - Street 1:4353 E STATE ROUTE 73 STE 170
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:45068-8838
Practice Address - Country:US
Practice Address - Phone:513-897-2211
Practice Address - Fax:513-897-2213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4971220001Medicare NSC
OHDB5937Medicare PIN
OHDA9339841Medicare PIN