Quang Khac    Tran    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004446
NPI
1396958211
Tax ID
200331078
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
6300 Stonewood Drive Suite 304
Plano, TX 75024
United States
County
Collin
Phone
4694678100 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address