Mary    McMains    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003739
NPI
1063607687
Tax ID
260528437
Effective Date
4/1/2012
Last Updated
10/23/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
5001 Bissonnet Street Suite 107
Bellaire, TX 77401
United States
County
Harris
Phone
7136648087 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address