William Trent    Tadlock    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003697
NPI
1043443849
Tax ID
203731649
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
6699 Chimney Rock Road Suite 200
Houston, TX 77081
United States
County
Harris
Phone
7136616500 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address