Sang    An    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004630
NPI
1477649895
Tax ID
262643255
Effective Date
4/1/2012
Last Updated
10/23/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
2625 Old Denton Road Suite 548
Carrollton, TX 75007
United States
County
Denton
Phone
9722421652 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address