Matthew    Barber    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004652
NPI
1487665360
Tax ID
202038982
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
6224 Camp Bowie Boulevard
Fort Worth, TX 76116
United States
County
Tarrant
Phone
8177376281 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address