Jennifer    Bird    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003593
NPI
1003048851
Tax ID
452477448
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
6734 Westheimer Lakes North Suite 111
Katy, TX 77494
United States
County
Fort Bend
Phone
2815740004 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address