Stephen    McKinley    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004501
NPI
1427054949
Tax ID
351844966
Effective Date
4/1/2012
Last Updated
10/10/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
207 Main Street
Williamsburg, KY 40769
United States
County
Whitley
Phone
6065490464 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address