Wayne    Maltz    OD
Contract Details
Facility name
Provider ID
P000004584
NPI
1457393688
Tax ID
760280881
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
5774 FM 1960 West
Houston, TX 77069
United States
County
Harris
Phone
2814405887 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address