1316464886 NPI number — NEW BRAUNFELS TEXAS STATE OPTICAL, PLLC.

Table of content: (NPI 1316464886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316464886 NPI number — NEW BRAUNFELS TEXAS STATE OPTICAL, PLLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW BRAUNFELS TEXAS STATE OPTICAL, PLLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
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Provider Other Name Prefix Text:
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NPI Number Information

NPI Number:
1316464886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2406 HUNTER RD STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN MARCOS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78666-5256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1705 S WALNUT AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRAUNFELS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78130-1116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-629-1248
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2017

Additional Information

Authorized Official

Authorized Official Last Name:
SABOL
Authorized Official First Name:
JESLYN
Authorized Official Middle Name:
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
512-658-3079

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  8234 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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