Provider Demographics
NPI:1366059065
Name:SHAIKH, NIMRA (OD)
Entity type:Individual
Prefix:
First Name:NIMRA
Middle Name:
Last Name:SHAIKH
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 1:135 FOREMOST DR APT 1205
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-7335
Mailing Address - Country:US
Mailing Address - Phone:281-352-6659
Mailing Address - Fax:
Practice Address - Street 1:5167 KYLE CENTER DR STE 103
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6621
Practice Address - Country:US
Practice Address - Phone:512-268-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9953152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty