Provider Demographics
NPI:1316940661
Name:SMITH, DANIELLE R (OD)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 BROADWAY FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-6216
Mailing Address - Country:US
Mailing Address - Phone:212-764-0008
Mailing Address - Fax:585-786-3699
Practice Address - Street 1:64 HAGER ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14208-1327
Practice Address - Country:US
Practice Address - Phone:212-764-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT006402152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02188732Medicaid
NY02188732Medicaid
NYCC8180Medicare ID - Type Unspecified