Provider Demographics
NPI:1285695148
Name:MIRABAL, SEBASTIAN M (OD)
Entity type:Individual
Prefix:DR
First Name:SEBASTIAN
Middle Name:M
Last Name:MIRABAL
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1025 LONG PRAIRIE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4242
Mailing Address - Country:US
Mailing Address - Phone:972-874-2407
Mailing Address - Fax:
Practice Address - Street 1:1025 LONG PRAIRIE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4242
Practice Address - Country:US
Practice Address - Phone:972-874-2407
Practice Address - Fax:972-874-2733
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX5878TG152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU97201Medicare UPIN