Provider Demographics
NPI:1306217880
Name:SAN MARCOS TEXAS STATE OPTICAL PLLC
Entity type:Organization
Organization Name:SAN MARCOS TEXAS STATE OPTICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:STANFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:OD/OWNER
Authorized Official - Phone:512-754-6161
Mailing Address - Street 1:2406 HUNTER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-5255
Mailing Address - Country:US
Mailing Address - Phone:512-754-6161
Mailing Address - Fax:512-754-6197
Practice Address - Street 1:2406 HUNTER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-5255
Practice Address - Country:US
Practice Address - Phone:512-754-6161
Practice Address - Fax:512-754-6197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-09
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty