Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 5878TG | TX |
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 5878TG | TX |
NPI | 1285695148 |
---|---|
Provider Name | Dr. Sebastian M Mirabal |
First Address | Flower Mound, TX 75022-4242 |
Second Address | Flower Mound, TX 75022-4242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2006 |
Last Update Date | 22/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U97201 | (02) | TX |