Jonathan    Cargo    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000003881
NPI
1134154206
Tax ID
061670320
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
1135 Kinwest Parkway
Irving, TX 75063
United States
County
Dallas
Phone
9724322020 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address