Elliot    Stendig    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004422
NPI
1396738647
Tax ID
751542293
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
1821 Old Mill Run
Garland, TX 75042
United States
County
Dallas
Phone
9724942020 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address