Healthcare Provider Details

I. General information

NPI: 1235204694
Provider Name (Legal Business Name): NIMIRA SAMJI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 05/30/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 ENDICOTT ST ENDICOTT PLAZA
DANVERS MA
01923-2515
US

IV. Provider business mailing address

139 ENDICOTT ST ENDICOTT PLAZA
DANVERS MA
01923-2515
US

V. Phone/Fax

Practice location:
  • Phone: 978-777-4700
  • Fax: 978-750-0862
Mailing address:
  • Phone: 978-777-4700
  • Fax: 978-750-0862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046010253
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4108
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: