Provider Demographics
NPI:1164905527
Name:WIMBERLY, DANIEL WAYNE
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:WAYNE
Last Name:WIMBERLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4206 CANTRELL CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5156
Mailing Address - Country:US
Mailing Address - Phone:281-881-7046
Mailing Address - Fax:
Practice Address - Street 1:19901 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-6538
Practice Address - Country:US
Practice Address - Phone:888-885-5367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician