Monica    Allison    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004437
NPI
1396884201
Tax ID
542098902
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
19202 Stone Oak Parkway
San Antonio, TX 78258
United States
County
Bexar
Phone
2104959020 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address