Healthcare Provider Details

I. General information

NPI: 1881785723
Provider Name (Legal Business Name): WAYNESVILLE FAMILY VISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4353 E STATE ROUTE 73 STE 170
WAYNESVILLE OH
45068-8838
US

IV. Provider business mailing address

PO BOX 1169
WAYNESVILLE OH
45068-1169
US

V. Phone/Fax

Practice location:
  • Phone: 513-897-2211
  • Fax: 513-897-2213
Mailing address:
  • Phone: 513-897-2211
  • Fax: 513-897-2213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. DANNY RUSSELL SMART
Title or Position: OWNER/OPTOMETRIST
Credential: O.D.
Phone: 513-897-2211