Provider Demographics
NPI:1922607274
Name:NIMEH, DANIELLE (OD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:NIMEH
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 1:6636 LAKE WORTH BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-3029
Mailing Address - Country:US
Mailing Address - Phone:817-626-4441
Mailing Address - Fax:817-625-7675
Practice Address - Street 1:6636 LAKE WORTH BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-3029
Practice Address - Country:US
Practice Address - Phone:817-626-4441
Practice Address - Fax:817-625-7675
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10130T152WX0102X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision