Clark  D  Witherspoon    MD
Contract Details
Retina Specialists of West Alabama
Facility name
Provider ID
P000001895
NPI
1386673838
Tax ID
631248335
Effective Date
10/1/2002
Last Updated
5/5/2014
Direct Contract
Yes
Term Date
7/22/2013
Status
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
500 Hargrove Road East
Tuscaloosa, AL 35401
United States
County
Tuscaloosa
Phone
2053430003 (Phone)
Billing Details
Address
P.O. Box 830674
Birmingham, AL 35283
Billing Phone
2059332625
Specialty Type
Ophthalmology
Map
Address