Gary    Nguyen    OD
Contract Details
Southmore Texas State Optical
Facility name
Provider ID
P000004341
NPI
1356375752
Tax ID
760208973
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
365 Greens Rd
Houston, TX 77060
United States
County
Harris
Phone
2818756800 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address