MEDICARE: DANIELLE NIMEH OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WX0102X	Occupational Vision Optometrist	10130T	TX
2	152W00000X	Optometrist	10130T	TX

General Provider Information

NPI Number	:	1922607274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE NIMEH OD

Provider Business Mailing Address
First Line	:	6636 LAKE WORTH BLVD STE 300
Second Line	:
City	:	LAKE WORTH
State	:	TX
Zip	:	76135-3029
Country	:	US
Telephone Number	:	817-626-4441
Fax Number	:	817-625-7675

Provider Business Practice Location Address
First Line	:	6636 LAKE WORTH BLVD STE 300
Second Line	:
City	:	LAKE WORTH
State	:	TX
Zip	:	76135-3029
Country	:	US
Telephone Number	:	817-626-4441
Fax Number	:	817-625-7675

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2020
Last Update Date	:	11/06/2020

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