Provider Demographics
NPI:1114983897
Name:SMART, JIMMY D (OD)
Entity type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:D
Last Name:SMART
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:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73802-0187
Mailing Address - Country:US
Mailing Address - Phone:580-254-8020
Mailing Address - Fax:580-254-8377
Practice Address - Street 1:1009 TEXAS AVE
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-3127
Practice Address - Country:US
Practice Address - Phone:580-254-8020
Practice Address - Fax:580-254-8377
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2471152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200070610AMedicaid
U33944Medicare UPIN
243603101Medicare ID - Type Unspecified
OK200070610AMedicaid