Keren    Perl    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003749
NPI
1073538484
Tax ID
201995794
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
5601 Bridge Street Suite 510
Fort Worth, TX 76112
United States
County
Tarrant
Phone
8174468778 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address