Provider Demographics
NPI:1013550342
Name:SEGUIN TEXAS STATE OPTICAL, PLLC
Entity Type:Organization
Organization Name:SEGUIN TEXAS STATE OPTICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESLYN
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:SABOL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-658-3079
Mailing Address - Street 1:2018 CARTER LN
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-2173
Mailing Address - Country:US
Mailing Address - Phone:512-658-3079
Mailing Address - Fax:
Practice Address - Street 1:515 E COURT ST STE 200
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5726
Practice Address - Country:US
Practice Address - Phone:830-372-1650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty