Stephen    McKinley    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003849
NPI
1124023809
Tax ID
351844966
Effective Date
4/1/2012
Last Updated
10/10/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
3810 South Highway 27 Suite 1
Somerset, KY 42501
United States
County
Pulaski
Phone
6066784551 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address