Provider Demographics
NPI:1215022173
Name:SMITH, DANIEL BRYANT (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:BRYANT
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 1:12656 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6240
Mailing Address - Country:US
Mailing Address - Phone:225-751-4100
Mailing Address - Fax:225-751-4103
Practice Address - Street 1:12656 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-6240
Practice Address - Country:US
Practice Address - Phone:225-751-4100
Practice Address - Fax:225-751-4103
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1229-378T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1437107Medicaid
LA118291OtherEYEMED
LAU88177Medicare UPIN
LA118291OtherEYEMED