Healthcare Provider Details

I. General information

NPI: 1114983897
Provider Name (Legal Business Name): JIMMY D SMART OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 TEXAS AVE
WOODWARD OK
73801-3127
US

IV. Provider business mailing address

PO BOX 187
WOODWARD OK
73802-0187
US

V. Phone/Fax

Practice location:
  • Phone: 580-254-8020
  • Fax: 580-254-8377
Mailing address:
  • Phone: 580-254-8020
  • Fax: 580-254-8377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2471
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: