Tuan    Le    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004112
NPI
1245405521
Tax ID
264244645
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1809 Eldridge Parkway Suite 107
Houston, TX 77077
United States
County
Harris
Phone
2814969615 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address