Theodore  D  Wind    OD
Contract Details
Facility name
Provider ID
P000003860
NPI
1124108360
Tax ID
161276307
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
45 West Main St
Little Falls, NY 13365
United States
County
Herkimer
Phone
3158234330 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address