Provider Demographics
NPI:1982089785
Name:SMITH, DANIEL (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 AVENUE K SE
Mailing Address - Street 2:VA MEDICAL CENTER EYE CLINIC
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4126
Mailing Address - Country:US
Mailing Address - Phone:863-294-3504
Mailing Address - Fax:866-522-3607
Practice Address - Street 1:5201 RAYMOND ST
Practice Address - Street 2:VA MEDICAL CENTER EYE CLINIC
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-8208
Practice Address - Country:US
Practice Address - Phone:407-629-1599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5116152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist