Anthony    Webb    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004625
NPI
1477560407
Tax ID
743025596
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
84.00
Location Details
Address
1720 South W.W. White Road
San Antonio, TX 78220
United States
County
Bexar
Phone
2103334340 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address