Kimberly    Turner    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004448
NPI
1396972436
Tax ID
742617908
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
5212 Broadway Street
San Antonio, TX 78209
United States
County
Bexar
Phone
2108298083 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address